Dismantling the Asylum and Charting New Pathways into the Community: Mental Health Care in Twentieth Century Canada

In 2007 Megan Davies at York University and I, then at the University of Alberta, secured a history of medicine grant from the Canadian Institutes of Health Research to launch a collaborative project called "Open Doors/ Closed Ranks." The project was inspired and supported by Bob Menzies and has since blossomed to include over twenty collaborators across the country, each of whom is developing new approaches to studying deinstitutionalization, or care in the community, in a Canadian region. Some of the results of those studies have been posted on our bilingual website www.historyofmadness.ca, which emphasizes the Canadian social history of this phenomenon and prioritizes patient and former patient perspectives above others. This special edition of Histoire Sociale / Social History represents the results of some of those studies and highlights the central idea of deinstitutionalization as an organizing principle for understanding more broad-based changes in Canadian twentieth century social history. Critical ideals about work, welfare, ability, health, gender, and human rights assumed new meanings, particularly in the second half of the twentieth century, and, as the following articles make clear, multifaceted changes to the mental health system have often underpinned these cultural transitions.

Deinstitutionalization in the most literal sense involved the massive depopulation of mental hospitals across the country. This maneuver, however, had a rippling effect across many sectors of society, including the economy, workforce, public health and education, human rights and, most obviously, mental health care treatment and facilities. Downsizing and eventually closing mental hospitals, formerly designed as asylums, was not simply an activity that was confined to the mental health system, nor did it exclusively affect former patients and their families. The changes wrought by deinstitutionalization were far-reaching for their impact on the Canadian economy and on human rights discourses, particularly those that hinged upon ideals of ability, disability, health and illness.

Indeed, these changes in the second half of twentieth century were perhaps as significant as those that had occurred during the previous century, amid state building campaigns, rapid industrialization, urbanization, and colonialization, all of which formed the backdrop to the rise of the asylum.² The twentieth-century context for the reversal of this trend involved a different set of ideological and cultural precedents, but contained remnants of some of these earlier influences. State building, for example, continued apace, but adopted new formats. Immediately after the Second World War, the federal government took on the task of reconstruction and reinforced or initiated a series of new programs, including family allowances, unemployment insurance and eventually health care. Collectively, these social programs contributed to what some have referred to as the 'welfare state.'³ By the 1980s, that goal had faded as neo-liberal policies were implemented in a growing number of countries. An era of Reaganomics took over in the United States, Britain faced Thatcher-style reforms, and Canada succumbed to a similar economic mantra as Brian Mulroney opened the Canadian border to freer trade and weakened the social services infrastructure that previous governments had developed. Under the new regimes of fiscal conservatism, the welfare state that had evolved out of the reconstruction period crumbled. A closer look at the details affected by these ideological shifts reveals the impact of such public policy on areas of child welfare, disability supports, and provincial programs for social services, health care and education more broadly.⁴ Primarily as scholars have pointed out already, the ideological shifts at the high political level created significant challenges, particularly for more vulnerable members of society, including patients as well as underemployed staff associated with these institutions.⁵

Industrialization accelerated with the SecondWorldWar, and one of the goals of reconstruction was to maintain levels of production and employment in peacetime. Yet the emphasis on one's value in the workforce continued to frame discourses on categories of ability and disability, as they had during the rise of the asylum. A number of scholars moved beyond the rigid ability/disability dichotomy and offered more sophisticated studies that considered how human value has been medicalized and how ability...