 All right, good morning, everyone. Welcome to another installment of the Health Law Institute seminar series at Sheila Wildman, Associate Director of the Health Law Institute. And today, it's my pleasure to welcome and introduce to you Dr. Erica Dick. Dr. Dick is a Professor of History and Canada Research Chair in the History of Medicine at the University of Saskatchewan. Her research explores the history of psychiatry, mental health, de-institutionalization, and eugenics. Some of that works, reached to, you know, the Scotia's own peculiar histories, at least in passing. Professor Dick's the author of two books, Psychedelic Psychiatry, first published in 2008, under the subtitle LSD from clinic to campus, and then re-released in 2012, with the subtitle LSD on the Canadian Prairies. She's also published in 2013, the volume facing the history of eugenics, reproductions, sterilization, and the politics of choice in 20th century Alberta. She's edited the volume of Cultures Catalyst and co-edited two volumes, one released in 2010, Locating Health, Historical and Anthropological Investigations of Place and Health. And just last year, another co-edited volume entitled The Uses of Human Experimentation for Assort Uses of Humans in Experiment, perspectives from the 17th to 20th century. So beyond all these important works, Professor Dick's many publications feature a series of pretty trippy titles, like Spaced out in Saskatchewan, Modernism Anti-Psychiatry, and De-institutionalization, 1950 to 1960, and Land of the Living Sky with Diamonds, A Place for Radical Psychiatry. Not only is Dr. Dick bold and imaginative in the subjects she takes on, she's often also made a point of engaging innovative research methods. This includes work she's done in connection with the Cura or Community University Research Alliance grant titled Living Archives on Eugenics in Western Canada. That's a project that's brought Dr. Dick together with other scholars, as well as students and community members to develop more inclusive resources on the history of disability reproduction and eugenics in Alberta. So that's it for the teaser, as it were. Let me turn it over to Professor Erica Day. Thanks very much, Sheila. I'm really pleased to be here, and snow did not deter me. It is 30 degrees warmer here than it was in Saskatoon when I left, so I consider this to be a nice balmy welcome. So thank you, and thank you all very much for coming. I'm just really pleased, and I want to draw special thanks to Sheila for inviting me, and for Barbara for making all of the arrangements and Constance and Archie for joining me last night. So it's kind of surreal being back here. I was actually an undergraduate student here at Dalhousie more than 20 years ago, and it's quite nice to be back. There's some things that haven't changed, believe it or not. So as Sheila mentioned, I'm a medical historian at the University of Saskatchewan, and my main interest and focus over the last little while has been on the issues of the history of mental health and psychiatry. I was originally drawn to questions around medical experimentation, and some of that involves some of the ethical work around human experimentation using LSD, but then I was looking more specifically at eugenics and the ways in which institutionalized people were sometimes kept out of the discussions around politics of choice and sexual autonomy even after the court cases in the 1990s occurred. So as a medical historian, I'm really interested in how we manage and regulate civil society and how those ideas change over time. And so today I wanted to talk a little bit about a somewhat new project that I've been working on, but for those of you who've known my work for a while, I have continued to go back to the history of Weyburn as this remarkable and sometimes unremarkable psychiatric institution on the prairies. So that's what I'm gonna talk a little bit about today. So as my title hopefully gets you thinking about this, I wanted to think a little bit about the history of asylums and institutions and the context of the spirit of reconciliation that we are engaged in now. And since the Truth and Reconciliation Commission was established, the language of reconciliation has focused our attention in Canada towards a nuanced examination of the trauma and legacies associated with residential schools. So what does reconciliation have to do with the history of mental health and illness in Canada? I am not a historian of indigenous people nor of residential schools, but I am interested in studying the way that mental health and its institutions, I think might and our histories of those ideas might take some important lessons from paying attention to the process of the TRC. I'm not going to argue that the experiences of residential school survivors are the same as psychiatric patients, but I will suggest that the process of seeking truth and building reconciliation is one we might learn from as scholars of institutions. One of the strengths of the TRC has been to reorient our thinking away from textual evidence alone and to pay close attention to the testimonies and oral histories of people whose experiences were more often negated or ignored. So learning how to genuinely listen to these stories is important for reconciliation, I think, and I also think we have much to gain if we are willing to face this history together rather than engage in politics of forgetting. And now for my historical reason. In 1961, when sociologist Irving Goffman wrote his famous book, Asylums, this was based on his careful study of St. Elizabeth's mental hospital in Washington, D.C. And in that book, he reflected on his own Canadian roots. Goffman grew up in rural northern Alberta in treaty six territory. He later moved with his family to Dof and Manitoba, located in treaty five territory. It was not clear that those places held any particular meaning to the budding sociologist when he trained at the University of Chicago, but he makes a small mention in his first book about the relationship between asylums and other total institutions, which is, of course, a term that he coins to describe the rather oppressive institutional environment that characterized mental hospitals. And he suggests in passing that these institutions share common features with Indian residential schools, as well as jails and penitentiaries. Although the vast majority of his work concentrated on the characteristics of people in mental institutions and later on the sociology of stigma, I think this brief notation is worth further reflection, especially in this moment of national reconciliation. So for today's presentation, I wanna share with you some of the work I've been doing with a team of people on the history of mental healthcare in the province of Saskatchewan. We began with a very simple premise. Why did we used to rely on large institutions and hospitals to accommodate mental illness? And why did we shift to a model of so-called care in the community? Is it time to look back at this shift and draw some insights from that history? So I'm not sure how many people are familiar with this prairie classic who has seen the wind, but it was the inspiration for the title who has seen the asylum. W.O. Mitchell's best-selling novel who has seen the wind, which was published in 1947, follows young boy's adventures in Weyburn, Saskatchewan. In this book, the Weyburn Hospital features as an institution at the edge of the city with a larger-than-life mystique. The book sold close to a million copies and became a popular text in Canadian school curricula. It centers on the life of a boy on the prairie as he struggles to understand the cycle of life and as he and his family survived the economic depression of the 1930s, which left a profound impression on him and his attitude towards others. For many 21st century readers, the depression is now part of history, though its impact is still felt today in the habits and attitudes of prairie families raised by survivors of this prolonged period of struggle. But the impact of that depression on everyday lives is beginning to fade from significance. As we remember the asylum, it too is fading from significance and fading from both the horizon and recent memory. It once loomed large on the landscape as a beacon of order and monument to civilization, making it one of the first things people would see as they approached the asylum town, like the one I'm gonna concentrate on today in Weyburn. And this is true of many asylums, not just of Weyburn, of course. But the asylum remained on the edge of the city, existing for some people as a legendary place where you go if you're misbehaving, the butt of a joke for local kids or a place that everyone knew but no one dared visit, making it part of the local culture while its insides remained invisible for most of the people living nearby. As the institution began releasing patients into the community, some of them became estranged from their social networks and friends, and some patients even returned, seeking once again the asylum or at least the remnants of the friendly encounters they had enjoyed inside its walls. By the end of the 20th century, after years of languishing behind boarded up windows and a crumbling exterior, the old asylum was torn down, leaving us to wonder who indeed has seen the asylum in its prime and who might remember its larger-than-life existence or some of the more intimate details of the thousands of individuals who passed through its doors. So the book we're writing today or now is on this topic and is as much about the history of the facility as it is about how we remember the asylum as a place that housed people whom we tried to understand, help, or even fix. Invoking the phrase who has seen the asylum, we are attempting to bring together those who fondly encountered the facility alongside those who gladly celebrate its destruction. And we're concerned primarily with how that place cemented certain legal, cultural, and medical ideas about citizenship. So today, even without the physical structure to house those ideas, we argue that madness often remains relegated to the edges of our communities. Or in other words, it doesn't matter who has seen or experienced the asylum. The stigma of mental illness persists in our current system even without concrete buildings. Now I'm gonna say a few words about the politics of authorship. I know I'd sent a paper around, I'm not sure if anybody had a chance to take a look at it, but that paper is a rather unorthodox experiment for historians. We tend to be loners. We work in the archives alone, usually in the dark with poor lighting, bad air. We don't make friends easily, but we are trying to step out. And Megan Davies and I were part of a project and Judith Fingard here was part of a project and Leslie Baker has been part of this in trying to build community, not only with other scholars across disciplines, but also with frontline service workers and ex-patients and consumers of the mental health system. And so these are just a couple of screenshots from a website we've put together called After the Asylum. It is part of a larger project on called History of Madness. And I see John is here as well. So I also part of the project. I don't wanna leave anyone out. So we've had an interdisciplinary bilingual project that involved where we try to put the experiences of people with lived experience first. So expertise comes from lived experience first and then flows from that principle. And it's a rather unorthodox project and we've had difficulty negotiating with publishers about how to put so many names on these for historians at least that's a strange thing. But that's the sort of spirit of the politics of authorship that I wanted to bring forward into this next book that we're working on. And so as I moved into writing a monograph which I'm wondering now if it's a polygraph it is not an edited collection. It is a book with a single narrative, so to speak but that is informed and inspired by a variety of perspectives. Some people take on more writing. Some people have more lived experience but we are trying to sort of harmonize or tame these differences so that we can sort of speak with a unified voice here. Not always a voice where we share all the same views but one that we can kind of harmonize those differences. So here's a list of the people working on this book project with just a brief description of sort of their background or where they're coming from. So myself and Alex Dayton, Alex was a master student with me. He's really taking the lead on the first three chapters. We have a former superintendent who was hired specifically to close the hospital. A former civil servant and I will just mention this anecdote about John Elias. John Elias was a psychology student in the 1950s and his first job was to drive out to the hospital and drive patients into the community of either Weber or Regina and help them find jobs. Often this was done without any kind of support or advanced notice to these employers who were then faced with a carload full of people who just left the asylum. This had a profound influence on the way in which he continued to train as a psychologist and ultimately when he became a civil servant and his job as a civil servant was to take the mental, or sorry, take the chart of rights and freedoms and align it with the Mental Health Services Act and he found those to be quite in opposition. So he was very much affected by those experiences. I don't wanna leave anyone out. Gary Gerber has been an anti-poverty activist in Ontario and also works as a psychologist, clinical psychologist and has done a lot to really raise awareness about the interconnectedness between poverty and mental health, primarily in Ontario, though he did spend a year in Saskatchewan which ties us all together here. John Mills is a retired professor of psychology in Saskatchewan and he died before this project could finish but he wanted to make sure that his words were not spilled in vain as he had a whole manuscript. So we've been working with his family and his widow to bring some of his work to bear in this project. Tracy Mitchell I am proud to say is the first peer support counselor hired by the province of Saskatchewan. She identifies as a psychiatric consumer and she's been instrumental in bringing a level of advocacy to this work and connecting us with some of the contemporary challenges in the mental health system. And then Alex Dick is now, he's not related to me, we checked over 200 years. There is an original Dick out there somewhere that brought us together but we don't think we're in conflict. He started off as a medical student and got an a bursary to do a project in something medical humanities and luckily picked us and has since gone on to do his residency in psychiatry and has been really instrumental in helping us work through particularly some of the diagnostic pieces as we look at this historically. Anyway, this is our team and here is literally an attempt to splice us together when some of us had met at Gary's house in Ottawa. So this is Alex, myself, Hugh LeFave, the former superintendent, John Elias, the former civil servants and Gary Gerber and the others were there either on the phone or by Skype or one had to catch a bus by this point the one we thought to take a picture. Anyway, so we got together a few years ago and our main question was first to understand why centralized services in large institutions were considered the best option for accommodating people in the mental health system and why and how a shift to community care occurred. And over the process of attempting to research and ultimately answer this question, we became keenly aware of how much of this history has focused on policies and buildings and less about the people who experienced these places and that is both staff and patients alike. And we have collected over 200 photographs so I'm going to be giving you just a few literally snapshots of some of these images. So when I came here today, I was thinking, how do I capture all of this history to a group of non-historians? So please forgive me for what I'm about to do. All right, the idea of institutionalization was a transnational phenomenon, certainly went around the world and lots of scholars have explored this topic. Many have interpreted the rise of the asylum as a response to capitalism, industrialization and even a product of civilization itself. At first, it was considered a progressive move that is in the 19th century primarily in an attempt to provide care for people who were otherwise left to face abuse in the community through poverty and often stigma and scorn for their poorly understood behavior. And there are many examples of scholars and scholarship that have focused on specific institutions. This one, of course, is the Queen Street Mental Hospital in Toronto, now the Center for Addiction and Mental Health and it also no longer looks like that. It looks like a mall. The Hamilton Psychiatric Hospital which was perched on the escarpment or the mountain if you were in Hamilton. The Riverview Hospital, formerly the Essendale Hospital in Porcoquitlam, BC and, of course, a little bit of local flavor, the Nova Scotia Hospital here. Many, if not all of these institutions were notoriously filled beyond their capacity by mid 20th century and they were draining energy and resources. By the 1960s, scholars including Irvin Goffman who I mentioned criticized these facilities as warehouses for societies unwanted. Sites of medical experimentation, sites for abuses of power, places that function more like penal institutions than places of healing or compassionate care. This is the stuff that fuels lots of dark novels, films and horror stories. This is the stuff of the snake pits. So our research began to show that not only was Weyburn part of these international trends but it was allegedly the last asylum built in the British Commonwealth. It was among the largest in the world and was certainly the largest employer in the region. We also found that 76% of the first patients admitted to this facility spent the rest of their lives in it. Weyburn opened its doors in 1921. Before that time, people were sent to the Stony Mountain Penitentiary in Manitoba or Fort Saskatchewan Jail in Alberta. That is until Saskatchewan became a province in 1905 and in 1914 built its own first provincial mental hospital in North Battlefield. Now to give you a sense of how many people were in the system by 1921 when Weyburn opened its doors. 346 patients were transferred from Manitoba to North Battlefield in 1911. By the time Weyburn opened its doors in 1921, 500 patients from North Battlefield were taken on a train southward accompanied by the RCMP, of course. Many people lived for several decades behind those walls. We know that the vast majority of psychiatric patients were buried in unmarked graves while a smaller number of bodies were sent to the University of Saskatchewan for research, mostly to the anatomy lab. The numbers make clear that being institutionalized in the first half of the 20th century was more often than not a life sentence. And to the best of our ability we're capturing some of the patient records and trying to throw some graphs here. I've got more I can show you if you have questions at the end but I'll try not to overwhelm with too many graphs. Basically our point is the numbers keep growing. The discharges certainly, there are very few discharges and some of the discharges that we can track. We have the raw numbers but we don't have the names so we can't necessarily track how many people are cycling through although we can make some informed guesses and the population continues to rise inside the hospital in spite of the numbers of discharges those people are coming back in, in other words. In spite of any claims to the contrary, oh sorry this is just a comparison of the North Battleford and the Weyburn ones and also I just wanna say that I am a qualitative historian and I realize why now. Numbers are really hard and they're complicated and the texts are not the same and it depends on which nurse was writing down things when they came in or whether you got a discrete number or whether you got additional numbers added. I'm not confident in other words in some of these numbers but I do think that the overall picture is that people went into these institutions and didn't come out. All right, hence my grave here. In spite of any claims to the contrary, maintaining relationships, families, finances or cultural contacts with the community was rendered virtually impossible in an age of limited communication and expensive travel for anyone without sufficient means which included the vast majority of the institutionalized citizens. The laws reinforced the severance. Indeed the confinement laws of the late 19th and early 20th century were primarily concerned with the protection of sane citizens. Segregation from the community partially fulfilled this goal. Committal was not voluntary, it was very rarely voluntary but instead prompted by letters from neighbors, family and ultimately determined by magistrates. Even physicians and psychiatrists took a back seat in most of these deliberations. Severing ties with families, employers or communities was justified at this time as a part of a humanitarian response to policing society and protecting the so-called good citizens from the bad. Bad citizens by virtue of crime or insanity or both crossed over a threshold at the gates of the institution that plunged them into a political space devoid of rational citizenship or the privilege of civil rights. Now once inside the institution patients were expected to participate in part of the hospital economy and of course part of this was justified as a piece of therapy. So moral therapy involved keeping you busy, engaged in gender appropriate work so men work on the farms outside, women do boring needlework inside, men work in the kitchen, women work in the laundries, believe it or not and work therapy becomes a very important part of keeping patients busy but it's conveniently also a very good way of keeping your costs down and maintaining an efficient facility which was very quickly recognized by administrators who wanted to keep down the costs. There's a number of pictures here of patients at work. By the middle of the 20th century however the mental hospital was recognized as severely overcrowded and the hospital at Webern achieved and I quote here the rather unenviable distinction of having the highest number of deaths in mental hospitals in relation to the general population for the entire country. So Saskatchewan at this time had a million residents and it had resources for just under 4,000 psychiatric beds in long-stay facilities but was serving more than almost 5,000 patients in that system so about 1,000 patients more than its capacity. So I wanna shift a little bit now to closing the hospitals and deinstitutionalization and I kind of like this image so I will use it. Starting in the 1950s administrators at Webern grew increasingly frustrated with the circumstances in the hospital and they engaged in a plan to shed light on the darkness of the mental hospital. The process has a number of layers but in brief it began with some of the figures featured here and I don't expect you to be able to recognize him from a distance but the figure on your right is Humphrey Osmond. For any of you who are interested he's also the guy who coined the word psychedelic. He's also the guy that gave Aldous Huxley his first mescaline experience and several more after that. So he sort of inspired the doors of perception which the doors, the band also took their name from. Anyway, Osmond was also the superintendent of the Webern Hospital and he was ashamed and disgusted by the conditions in that place. So he intentionally set forth to shame the local government by producing some of the images that I've been showing you here, not this one but some of the ones that are fairly desperate. He wanted to publish these in the local media and he wanted to present these images to Saskatchewan residents to really show people what conditions patients were living under. Now remember, the socialist government was in charge here at the time. So Tommy Douglas had been elected as premier of Saskatchewan at the moment. Osmond was very sympathetic to the socialist inspired health care reforms but nonetheless he wanted to hold Douglas's feet to the fire in terms of changing mental health care as well. So he hired photographers and they came to capture some of these images of what he describes as the more desperate and shameful features of human existence inside the hospital. And although his plan worked to some degree it was combined with aggressive efforts to bring in social workers and bring other frontline health care service providers into the hospital to help ease this transition into the community. Now Osmond ultimately left in 1961 mostly because his wife actually complained about the winters bitterly for a very long time and I've just been going through their correspondence and I feel confident in saying that. But before he left the American Psychiatric Association recognized Weyburn as the most improved institution in North America. Osmond was however disgusted by this plaque and he felt the hospital did not deserve as he felt that there was very little to show improvement in the lives of his patients. When he left another group of reformers stepped into his position. One as clinical director and the other as superintendent of the hospital and that was Hew Lefebvre who's now part of our project. Hew Lefebvre took over as superintendent with the express intention of closing the hospital. Meaning that while the mental hospital at Weyburn was allegedly the last asylum in the British Commonwealth it was also the first in Canada to significantly deinstitutionalize its patients. And I suggest there are many reasons for this. Not the least, these are some of the images from Osmond by the way. Not the least of which was that the province was already engaged in widespread healthcare reforms. Namely, what would lead up to Medicare. And concentrating on investments in general healthcare put pressure on changes needed in the mental healthcare system. So by 1957 the Federal Hospital Insurance Diagnostic Act or HIDS, one of the founding pieces of Medicare had fundamentally shifted public policy and government spending such that no provincial psychiatric institutions could benefit from cost sharing arrangements. And general hospitals meanwhile could build psychiatric wards while the federal government would pay for half of that, half the bill. So again I will just give you a little bit of historical context which will be thin on actual historical detail. But it's important I think to bear in mind that while these political changes were taking place and while the policies around general and mental healthcare were sort of coming into alignment and changing rather significantly there were also a variety of other cultural and medical changes taking place at the same time and I just want to point out a couple of those. So it's not just Medicare that drives this change of course because we also recognize this happened outside of Canada. Psychiatrists were very interested in shifting away from these large scale facilities. They argued that putting patients in general hospitals was a good move to help reduce stigma and to increase clinical efficiency. Not to mention this was going to improve the professional prestige for psychiatrists and many recognize that. Families and ex-patient groups were beginning to form and already were arguing that Longstay hospitals had severed relations with families and that outpatient stays were more beneficial for maintaining social contact and they recognized this as key to maintaining healthiness. The Canadian welfare system had grown to include a wider array of social services while service providers and families alike pointed to them as pointed to these kinds of services as proof that we were in fact a more caring society by the 1950s and we were therefore capable of absorbing more people into our communities which was usually a code for into the workforce. And finally but I think significantly one of the primary treatment modules for psychiatric care at this time was also shifting. So people were moving away from segregated institutional care to psychopharmaceutical care. During the 1950s there were more psychopharmaceuticals on the marketplace than ever before or since. Anti-psychotic drugs namely cholopromazine decreased psych, excuse me let me try that again. Decreased psychotic symptoms such that it appeared that people could function in the community. Now of course we quickly learned that this was not sort of a simple case, there were long-term side effects but the idea was enthusiastically embraced by people both patients and staff alike who had for decades been languishing in these hospitals with very few advancements. So one of the things that we wanted to argue in this project is that the shift from psychiatric institutionalization to what becomes care in the community although loosely defined represents one of the most significant paradigmatic changes in social welfare policy in the 20th century. And I will look around for see if anybody is going to agree with us on this. Closing mental hospitals became a transnational phenomenon and implicated nearly every part of the public policy arena with concerns that ranged from housing to employment services, policing and child welfare, community drop-in centers, public libraries, educational policies, mental health care, aligning with Medicare, legal advocacy, marriage reforms, dependency laws, the state holdings, taxation laws, anti-poverty coalition, anti-sigma campaigns, literacy networks, they're a whole host and the lists go on and on and on about the kinds of features within our communities that were affected by these changes or should have been affected perhaps we could argue. In fact, it's difficult now to imagine a corner of our civil society that is not entirely untouched by our decentralized mental health system. Now for patients, closing the hospital was of course more complicated than simply shutting down wards. It was deeply personal, I'm just gonna grab my coffee. Former patient Kay Parley reflected on what this meant for her as someone who had lived through these changes and before going to college Kay who for a while used the non-deplume Norma McDonald was institutionalized and told that she had schizophrenia and what she writes is it seems unlikely that I will be able to say anything understandable about schizophrenia because as a sufferer, I've never felt certain to begin with that I am living with schizophrenia. So for Kay, the hospital had functioned as a retreat from a less than sympathetic community. Now these are just some images from inside of Weyburn. It was a place in which she was expected to be schizophrenic, to perform a series of behaviors, to display a number of symptoms that proved her label. And in this respect, the hospital provided a degree of comfort to her as she was encouraged to let her schizophrenia run free rather than masquerade as though she had harnessed it or suppressed the part of her that was schizophrenic as if she could cut it off at some point and remain whole. If anybody's interested, Kay Parley also took LSD with Frances Huxley and has written a book about it. She was interviewed on CBC The Current a few months ago. It's a great interview if anyone is curious. In another example, this is a picture of Jane White and her book. Jane White is a psychiatric consumer who spent time at both the North Battleford facility and in Weyburn and has now published a history of the Canadian Mental Health Association in Weyburn, sorry, in Saskatchewan. And she, I think, has another important part to this history. She argues in her book that deinstitutionalization created an opportunity for massive disinvestment in mental health services. The changing political economy of health in combination with oftentimes an intolerant and unwelcoming community, she argues, has led to a set of uncoordinated services in spite of massive public investment. In her story, she illustrates how difficult it was for her to find the right kind of treatment which she did through a string of outpatient visits, emergency admissions, self-help and support groups and a litany of housing coalitions and sheltered work. In total, she argues that she cost the system over a million dollars in her first year out on her own, as she puts it. Once she got the help she required, she was dramatically reduced her cost to the system but finding coordinated care was very difficult. And Jane explains that deinstitutionalization helped to establish a new set of hotlines or crisis prevention services aimed at addressing acute needs, but what many people need, she argues, are warm lines, a friend to talk with, an advocate to help navigate a piece of bureaucracy or a complicated application, a companion to share meals with after relocating from a busy ward to a lonely apartment in a new community. She says, every day I stay out of the hospital, I save the province $1,000. That's more than they offer me in social services benefits for the entire month. It doesn't add up. So I wanna conclude and open up for some questions and I think it's a cliche merely to claim that the problem is complicated or that individual experiences are diverse or there's not a one-size-fits-all solution. The psychiatric hospital or asylum was a blunt instrument for managing extremely subtle and complicated sets of problems, only some of which were clinical. Conversely, the community arose as a bastion of independence and a fertile breeding ground for autonomy and even liberty. If we characterize the asylum as an affront to independence while expecting the community to organically produce the conditions for a thriving autonomy, I think we run the risk of oversimplification. And while few people will argue that the asylum should be resurrected, many might agree that there's no more life and liberty in a life of poverty and discrimination than one plagued by so-called hospitalitis or total institutionalization to Borough Goffman's term. So if Webern serves as a case study, it reminds us that neither large investment in the admittedly large institution nor decentralized relatively thin investment in care in the community has generated success if we judge it by the point of view of the consumers of the system itself. So bringing people who identify with mental illness directly into discussions about the future of mental health care may be a necessary first step for designing a more nimble system, particularly one where individual autonomy is the goal. Perhaps those of us invested in the future of mental health care system should pay close attention. Sorry, I missed my cue here. I just love this picture because it's hard to guess who has the power here. Here, that's what I'm looking for. I think we should pay close attention to Justice Murray Sinclair and the outcomes of the Truth and Reconciliation Commission. By acknowledging the history of the residential schools in Canada, their dark pasts and the contest over how these institutions should be remembered, the TRC claims to seek the truth and then set the stage for a period of reconciliation. I think the asylum and the residential school share some common historical features, one of them being a hesitancy to listen to the stories of those who experienced these places. Their stories are often written off as anecdotal or poorly informed as to the larger context. In the spirit of reconciliation, however, perhaps we can listen to these voices and discover the people who lived behind the walls of the asylum. And I will end here with our hopeful book if this ever gets finished. Thanks. Charlie, yeah. So hearing that you're using archival sources and interviewing people and memoirs and a rich array of sources, maybe even local newspapers as well. So you'll applaud me with the album for the AT&T. And your reason for doing that, coming out of the logic of the Truth and Reconciliation Commission is that you think that there's a larger kind of project of social, reliable memory that you're serving and I agree, I think that's right. One of the signs, I guess, that I looked forward to be sure that that kind of project was actually delivering would be some moments of surprise for you as a researcher. Things that you really feel that you found that jostled a little bit, some of the narratives. If something, the narratives that you've given them today feels fairly humiliating. So I guess could you tell me a little bit more about how do you think your method has redirected you from doing it? Yeah, thank you for that question. One of the things that has really caused us to stop in our tracks and reevaluate things is how fond some people's memories are of these places. The connection that they have, and it's not with the horrible sheets that they had on the beds, that is a constant complaint, the poor clothing, the poor food, but it's the community that existed inside of these institutions and the challenges of trying to recreate a sense of friendship and community and warmth and acceptance and belonging in a community that's very, very different, organized around different principles that's supposed to be a better place, a more autonomous space for people to engage in their lives, but where they find it very difficult. And that's been one of the things that we are trying to retain as we move through this, is not simply to reinforce the snake pit version, although it was an effective form of rhetoric to draw attention to the hospital and to some of the very, very necessary needs for reform and the ways in which mental health services has been just underfunded, I would argue, forever and continues to be. But also trying to think about some of the ways in which this is not a medical problem and it's not simply a political problem, but it's a social problem as well. And that has been something that we are trying to sort of think through. So what does that mean in terms of how we listen to the sources, how we read the sources, where we look for these ideas and sort of challenging the way that we're trying to gather evidence, I suppose, or materials to put this together, I don't know if that answers your question. Yeah, I mean, you bring me up really well. I know, I was in your talk, and I was in the trade. So one, I think, small hollow question there. I was going to ask you a question about gender, and this comes out as a question about gender. The historians and sociologists writing about friendship, the friendship in the general population now is a kind of different way that women and men are socialized experience in the world. And I guess I've been asked you in terms of the people living in the community, whether there's a different challenge instead of issues for men and women in dealing with the social question. Yeah, and I'm gonna do a bit of a dodge. This comes up really explicitly, and this is where the dodge comes in. So in the work that I was doing on survivors of the eugenics program in Alberta, it also was working with community and working with a number of people who were comfortable coming forward to tell their stories. Most of those were women, not all. But now we're also dealing with a different, a slightly different set of questions. We're still dealing with institutionalized populations, but these are people for whom their reproductive choices were taken away from them. And the men didn't wanna talk about it. They didn't wanna engage in this. There were a few who did come forward eventually, but for them, they mostly wanted to talk about the conditions in the hospital and the fact that they had had a vasectomy, sometimes, often between the ages of 14 and 18 and almost invariably without their consent or knowledge, they didn't wanna talk about that part. But the women, for the women, it was a much more profound connection in feeling that they no longer had the right or the choice of having children. And so they came forward, and it was partly how we do our research, we find our networks of people, and then you find other networks of people related to those people. So I think partly this is a bit tilted because we came into this asking questions about sexual sterilization. But it does seem that so far in our best efforts, it's mostly women who wanna come forward and talk about these things. And it's a lot of women who, when they left the institution, and particularly in the case of Alberta, where they had also been sterilized, the only jobs they could get were taking care of other people's children, which is profoundly ironic, I find. And it meant a lot to them to be able to talk about this and talk about what it meant to have been chosen to live in an institution because they were considered incapable of responsible parenthood, that's in the language of the law, and then to be raising other people's children. And so they formed their own networks in that context. And that's some of the networks that we've been talking to. So again, that's a sideways answer to your question. Sorry, there's a question here and then there, yeah. Approach and incorporating survivors into your research. But you're talking a little bit about the snake pit fiction of its items as being a historical approach, but mad studies in Canada and in the UK is certainly still using that. And in great recent studies, a lot of critical criminologists are using the institutionalization of that 100% successful case to me with no redeemable features to that historical. So my question is, how are you dealing with that? Because most of the folks writing and publishing on this with survivors have a very different approach. Yeah, so I've been part of mad studies. We've also had, I intentionally wanted to get people from that perspective to read sections of this because it's been a really challenging question. And I think you're absolutely right that both in the UK and like PSAT, for example, the Psychiatric Survivor Archives of Toronto and they've been part of the Critical Studies Reader, they've certainly had a much more rigid perspective on seeing these institutions should be abolished. And we see this also actually in some of the questions around what to do with residential schools. Should we destroy the schools? And some of the survivors actually say, no, you have got to keep them so that we don't forget. And I think there's room within the mad studies scholarship as well to at least have that conversation. And not everybody's going to agree with us for sure. And not everybody has agreed with us, but I'm heartened by some of the response we've had to some of the preliminary presentations that we've given where even people who are absolutely, Don Whites, for example, who has said, you know, burn the place down. I mean, he takes a very sort of almost anarchist perspective on this. And he says, well, you know, I guess, you know, there are people who have different perspectives and I want to write that down, you know, put it in the sky. So I think there is room for this conversation. No one on the project is suggesting that what we need to do is, you know, have another big hospital and, you know, we'll recreate this community. But what we want to talk about is the importance of human relationships and the importance of listening to this variety of spectrum of interests and spectrum of ways in which the asylum-affected people and how we remember it as Canadians across the board. So I don't know, we're trying to be diplomatic about it, but we also, I don't want to ignore those perspectives as well. And they do show up in the project that we don't want to mute that, but we also want to put it into conversation with some of these other ways that maybe remembering is an important way of moving forward. I don't know if that answers your question. And there was a question at the back, and then Judith, yeah? Thank you for your presentation. You've presented a fantastic critical analysis, writing lines, what I've been thinking. I was wondering if, in your research, you encountered any examples that illustrate a better approach that we can learn from. It seems like most of what you've been talking about is reasons to seriously question both institutionalization as well as care and the care in the community. But I'm sure there are some places that at least in some ways have been getting it right, and I'd be interested if there are any examples. Can I rest that with the whole group? I think there are elements that we have improved upon, and I think there are elements that we do get right. I'm not sure that, I really think that thinking about this as a one answer is really wrong-headed. I mean, we know that experiences with mental health is not all the same. Not everyone is suffering from a psychotic disorder. Depression doesn't look the same as ADHD. We have a variety of circumstances that people are faced with, and pushing them all through the same door, I don't think is the right answer, and I certainly don't think that pushing them through the emergency room door, and necessarily medicalizing these problems is the right answer. Some of our colleagues in the United States are really focused on the ways in which these, the institutionalization has just created a re-incarceration in the jails. Now, their story I think is really interesting, but also different in the simultaneous privatization of the penal system, and creating these private jails which sort of feeds upon some of these ideas in different ways. We in Canada are in some way sheltered from that, but not entirely, and I think if I had more coffee, I could try to answer this better, but I sort of want to come back and have a bird's-eye view of a variety of different ways that we've sort of leaned on institutions to help manage these problems for us, and maybe it's not institutional networks that we need. Maybe we need to invest in literacy, or safe housing, or guaranteed income supplements, or reinvest in the welfare state, heaven forbid. But I think sort of moving away from seeing this through a medical lens entirely is one of the first ways to move forward, and there are elements and pockets of places where that has happened, but I don't know, I would search this intelligent room for suggestions for good news stories of like a system that works, because I don't think it's one thing. Judith, yeah. Well, this is institutionalization, and there's institutionalization, and there's just two more things I want to make, is that we were just trying to study Actis and Nova Scotia, and you know we had a two-tier system, and so you have a kind of two-tier hospital, and then all these chronic care hospitals doesn't offer them well into the 1960s, and so that's a huge difference from Saskatchewan on the suit. Yes, absolutely. Because they're not particular. These people didn't graduate, if they couldn't do anything, when they didn't graduate to an institution where they would just be in fear in your past. Yes and no. Yeah, so. Was there anywhere else for them to go in an institution besides the jail? It depends on which time period we're looking at. In 1946, the province opens up two training schools. So they start siphoning out people who are sort of under the umbrella term of mental deficiency at the time. They also start opening up a network of old age homes, nursing homes, and of course, this is happening across Canada as well, and so Nova Scotia is interesting, and we were actually talking about this last night, in that they really like, you really like to build institutions, and keep people in these institutions, and there are some similarities, but Nova Scotia also stands a little bit alone in hanging on to these ideas, it seems. They persist for longer, and we should talk about our next project when we compare this. The other thing that I want to make is, just because I have some experience with volunteers and dealing with current people who have suffered from mental ill health, as they say in England, they're in and out of hospitals, I mean, not that kind of hospital, but they're still in and out of hospitals now. So you see people functioning in the community, often involved in some work within a kind of social network framework, some of it's paid, and getting on quite well, and then suddenly they're not there anymore, and you realize they've been admitted to the Abbey Lane or the Notre Dame Hospital, and they have a long session, and they have 50 to 60, if they're suicidal, they're likely to have 50 to 60 ECT treatments before they're even allowed to go back home. And so I guess, what's institutionalization like today? Well, one of the things though, when they're in the hospital now, at least they're escaping the poverty and the bed bugs that they lived with for most of the time in this city. And this sort of comes back to Shirley's question in that, you know, these are snake pits, but there's something good about them, and this is what I'm hearing as well, particularly. So what we've tried to do to maintain, on Unimity and meet our ethical guidelines, is to collect some of the contemporary experiences that people have shared with us who didn't want to go on record. So we've kind of taken some creative liberty with their help and their guidance to transform their stories a little bit. So you won't recognize who they are, but I'll know who they are, you know, because I talked with them. And bed bugs has come up in every one of these examples of people who are coming into the system and saying, you know, I don't wanna leave the hospital and I don't have to stay here and they won't keep me here, but I don't wanna go home to that bed bugs. And I don't wanna go home to that shared apartment and I don't wanna go home to, you know, the food bank. And it just keeps, it's, you know, there's something lost in the institution as well. And it isn't, it's more than just those from friendly relationships. I mean, I think it's poverty actually, you know. Well, I know you're covering quite a scope, but any people who were in the institution and are now only the people, obviously, because it's cold as well. Yeah. And so they can compare their freedom of experience with their current experience? Absolutely. Yeah. Absolutely. So Jane White, who I featured here somewhere, she has been, you met Jane, I think, when we were in North Battleford, she was with us. Jane was institutionalized at North Battleford. She was institutionalized at Wayburn and she now bounces, as she says. But she tries to keep herself out of the, the medical part of the system and engaged with things like Crocus Co-op, which is an outreach place. It's a community center. It provides, you know, library and some facilities, but you can't sleep there, you know. So there's, there's social support, but very little else. She's been really critical for helping us to think through some of those questions as well. She's the one who has suggested to us, you know, what we need are warm lines, you know, these sort of soft, softer approaches. She would argue then, you know, full-on admission to a hospital or finding yourself in jail or, you know, the Shawshank Redemption sort of phenomenon where people are committing petty crimes so that they can get institutionalized because it's better than the alternative. And that is certainly part of this. Mm-hmm, that answers your question at all. I'm just feeling sort of depressed now. It is depressed. Yeah. As a loss of management and reliability, so is there any, in your kind of research and institutionalization, is there any, like, equivalent of wrongful convictions in the kind of asylum style? Absolutely. I mean, I can think more clearly of the historical cases because partly because we can get better access to those records, once enough time is passed, we can get a more fulsome description. So the more contemporary examples are usually sort of aggregated and we can't get enough detail to give you a good answer on that. But absolutely, I mean, during the Depression, we see spikes in the numbers of unemployed men who are institutionalized. You know, why is that? Are they, you know, is there something wrong? Is the Depression really hard? You know, we also see women not being admitted to the same degree, even though there are women trying to get admitted to the hospital at that time and the state is turning them away. The same time that the hospital becomes federally recognized as a deportation center and they start looking into the backgrounds of people who are coming into the hospital and saying they're a drain on our society, we'll send them to Italy or wherever, right? So it's tangled up in a whole variety of things that I think a lot of these people, some of these people certainly weren't there for medical problems, right? And like I say, the earlier cases are easier for us to make that claim because we have more detail about them. I don't know if that's a, yeah. Just got a question from the book from which you took your title from W. O. Mitchell's book. I'm wondering if, apart from that waiver that you found yourself into the sort of imagine of literature, of poetry, of song, of substructure, I mean, apart from the books you mentioned, at least I asked it because I can recall I've never been to a waiver and I recall as a seven-year-old in Moose jobs. I wouldn't say one of my friends was acting a little bit odd. You're crazy, but you should be a waiver. It was just called, I asked her, it said, me, woman. I still can't look at one word on them. It's like Benville. Yeah, yeah. But it's the same thing. If I tap my arm in that, I just can see waiver. That comes back to me. And it's, I say this, I was unusual in that, that sort of infused the discourse of probably not just children, since it's actual, and I'm just curious, as a part of Mitchell's book, which most people know, is it spread into the song, the literature of substatuary in other ways? I'm gonna have to listen a little more closely to Joni Mitchell and see what she says. But it's a good question. I, people talk about it. I think in Sarah Banks, I think it comes up as well, the tale of Sarah Banks, this woman from the prairies. Anyway, there's some pieces of local literature where it kind of the specter of the asylum. And for some reason, it's often wayburn and not North Battleford, even though they function politically on the same plane, so to speak. But this is true of other places as well. Like you said, Bedlam Queen Street has that kind of mystique about it. And when I was doing my PhD, I was living in Toronto when I was volunteering at the Center for Addiction and Mental Health. And certainly that whole area around there, it still captures that cultural sense of that place, right? That place that is scary, but we don't really know that much about what's going on inside. So I think there's probably more in there. Now Webern gets, one of the things that I will say in trying to look at Webern is also it's sort of a champion for Medicare. It's the hometown of Tommy Douglas. It is his constituency. And you get these sort of competing stories about this place as a site of innovation and championing a kind of socialist view or place for healthcare reform, but also kind of this epicenter of, may not be surprised why Webern also kind of developed those and facilitated some of those thoughts. Douglas, of course, had worked at Webern. He was an intern there. He worked there as a summer help. So he was intimately familiar with the place. So you mentioned that you're looking at the social problem not necessarily that political. And so I'm wondering in terms of your lived experience and looking at those, if you looked at the people who lived in Webern at the time and getting some of that perspective as well, because as much as there was a community inside, there's also that relationship between sort of a immediate community outside of those insides. I'm wondering how that plays into the work that you're doing at this point. Yeah, absolutely. And again, I'm sure this is true of places other than Webern, but this is the one that I'm more familiar with. So I've gone there and given talks at the public library and sort of sat down in the hotel, although they just found oil in the sand there, so now they've got a Tim Hortons and there are more hotels. But when I first started this project, there was one hotel, which is apparently where W.O. Mitchell wrote most of his books. So I had to go there, of course. It is also the only bar in town. So I went there and just met with people and chatted with them about different things. And of course the librarian knew everybody, so he also introduced me to a number of people. And it was very interesting, because although that was, when I first started doing that, it was the early 2000s, the hospital was still in existence, but it was all boarded up at that point. And everyone wanted to tell me about ghost stories that they'd heard about this place or about kids who would break in there after hours and a variety of tales of the place. But very few people had gone near it, except for a few people who came to see me at the library after I gave a talk. They showed up the next day. I just said, I'll be at the library if anyone wants to talk to me. And they came over and they said, you know, I used to work there. My aunt was there. And they were much more tender and wanted to talk about it. But there was clearly a sort of town and asylum divide. And I think in other literature about these asylum towns, we find that classically the case. There was a lot of resentment. And we see this definitely reflected in the local newspaper. When they first started looking to release patients into the community, the mayor actually tried to ban it, even though he had no jurisdiction in doing that. But he started publishing things in the papers about lock up your kids. School will be canceled. There are patients running loose in the community. So I mean, clearly there was a very distinct divide between some of the administrators in the town as well as the town's folks. However, it was also the biggest employer. So they were sort of dependent on the place too. So it's this complicated relationship where it provides employment. And yet, it also is this sort of fearful place. Do you think that pop culture has influenced that dichotomy between the asylum and the population in terms of how people consider the asylones? Absolutely. Do you think that that has an impact on that as a negative in terms of it being integrated into this society? I teach medical students occasionally. And one of the things that I came across this article about medical students learning about ECT and lobotomies before they'd seen one flu of the cuckoo's nest and after. They learn about it from apparently somebody else who did this about these are good treatments. They are positive. They are progressive. And the survey shows, the students were set up for this obviously, the survey show that students are kind of, OK, well maybe these show some benefit. They watch one flu of the cuckoo's nest. It's like 97%. This is abuse. This is horrible. Absolutely. We also know that there are so many films about these places that they feature in horror films. They are usually, I can't actually think of a nice film about an institution. Please challenge me and show me that I'm wrong. But they tend to reinforce those kinds of ideas. One of my students is now teaching a course on madness in the movies. And this is precisely what he's also demonstrating. We reinforce these ideas of madness and dangerousness, madness and violence. And most horror films feature some kind of specter of madness as the sort of core feature of this usually psycho, literally. And so yes, I think that those ideas, those popular cultural ideas continue to plague our not only ideas about stigma but also the relationship between the institution and the community. Definitely. So I really enjoyed your talk. And I love your title. It's asking us questions about how we construct your memory and through our own sense of place. And so what an institution is and what an asylum is. So I've got two questions, I guess, around those questions for you. One going to your preoccupation which is so important with institutionalization. So what is an institution? So for instance, CACL, Canadian Association for Creative Living, as I understand it, you know, understands an institution not to be defined by necessarily the mass of people who are included there but the power relationships and the denial of opponent private people there. But that's sort of one question that I wonder if your research gives you some sense of the parameters of what is an institution. And then the second part of that goes to your expertise question, which I also loved your photograph, you know, who is the expert here and how do we even ask this question? But that becomes very complicated as you know. So what is expertise in relation to institutions? And there it seems to me like you run into some of the really difficult politics of mental health identity, for instance. So on the one hand, you've got a very clear group which is what you call institutionalized population. So folks who live through labor and other rest of it who find those people and get their narratives impacted. And then you've got those designators that use consumers, survivors, ex-patients. And I wonder to what extent in that sort of the politics of identity there and of expertise you encounter people who may have difficulty fitting them, sort of identifying in a sense because you might not be a consumer, but you could be a consumer and be someone who's never been involuntarily institutionalized and yet still claim a form of expertise around this thing. Absolutely. And all the rest, you can see the difficulty. So I wonder to what extent those kind of preliminary questions, definition in a sense and identity, I don't know, trouble or inform? It continues to trouble and inform. Yeah, I mean, I think when we first started this off, well, to be honest, when I first started this off I thought I was gonna just be plugging away at this project that I thought was important, but I didn't really know why or how or what it was gonna look like. Kind of working by myself. And the more I got into it, I recognized that I had some skills that I could bring to it, but I didn't have the sort of spectrum of things that I needed in order to tell I think the story that needed, in my view, needed to be told. I needed to rely on others to help me understand and not as a consultant, right? And that's what became important that I didn't want to consult with or take stories from people and kind of take them as my own, which is often what we do as historians. I mean, that's just our training and that's what we do. But it seemed to me in this particular case, and it was really the impression formed on me as I was mentioning last night that I worked on this project on eugenics, creating the living archives of eugenics. And it was really working with people who had been institutionalized and developing relationships with them over, well, now we're about 10 years now we've been working. And some of those people at the beginning did not wanna tell their stories, did not feel that their stories had a place, didn't wanna remember, and that was fine. But over time as they kept coming to these meetings, some of them said, well, actually, maybe my story does have meaning and maybe I do wanna tell my story and can you help me tell my story? And it was sort of a process that had to develop over many years of developing those relationships where people's identities changed in those relationships as well. So we may have come in and said, okay, well, you're on the board because you survived institutionalization. And some people came out the other side and said, I wanna call myself a survivor. And some said, I don't wanna identify that way even though they had a very, superficially a very parallel path through the institution we might say. And so we've had to learn to sort of be open and flexible to how people wanna self-identify and who wants to volunteer to work on this project. To that, this is my bad answer of, we've tried to be sensitive to identity politics but also not put a box around it. So we weren't trying to fill a quota. We need to have so many people who identify as survivors because those ideas change. One person came on because she said, I'm a political advocate for anti-poverty. And through the process, she decided, she said, no, it's more important that I identify as a consumer because that is something that I've never been able to say publicly before. And she said, this project has made me proud of this. And I had no idea, of course, when she came in. She came in because she was really interested in providing supports in the community. She worked for the Food Bank. And so it's interesting how the project has changed those policies. It made us think about which labels, we are intentionally fuzzy on some of those labels and try to address that up front and say, this is what we're working with today. Is that an answer? Oh, I think that was very, it's complex but I'm glad you brought in the poverty element because at some point, I think part of the danger in this politics is you can focus on mental health first. And so what we need is a place to put these folks as opposed to, as you've been taking this back to so often, focusing on the bigger structural questions of, because the poverty being at the root, and what you need is a response to poverty. So you don't construct these problems anyway. It's tough. And I think I didn't answer your institution question at all. Eva, who has seen me as a woman? I don't know. It's true. Is there any other questions? Everyone's hungry. Thank you. I'm gonna do that. All right, thanks. Well, hold on. So we're gonna give you a formal thanks. Well, first I want to just give a plug for our next seminar coming up, which is Friday, March 10th. And that's Barbara Noah, who's here, I think. Barbara, there she is. And she's going to speak about the end of life decision making in the U.S. with some Canadian comparisons in Friday, March 10th. So I want to thank all of you for coming out, raining the snow, and of course, also Erica. I think her plane got in at 4 a.m., not yesterday, but the day before, after many delays. For my part, I feel I'm much more equipped to see, or at least to start looking in earnest for the asylum, particularly as it exists here in the Wisconsin, as a fixture of our social policy. I think we should all be alert to that. So thank you, Erica, for your excellent presentation today. Thank you so much. Thank you.