Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario by James E. Moran (review)

humanities 423 university of toronto quarterly, volume 72, number 1, winter 2002/3 way that the General exemplified these trends skilfully illustrates the extent to which British and American models influenced one Canadian city. In Part 3, >A Major Academic Hospital, 1904B2000,= Connor continues to describe how the changing physical structure of the institution reflected international norms of hospital construction, how the lay board spearheaded the redefinition of the hospital=s relationship with the University of Toronto, and how the challenge of funding the ever-expanding demand for services contributed to the eventual creation of Ontario Blue Cross and the Canadian medicare system. As well, he outlines the direct impact of political decisions in the 1980s and 1990s which resulted in significant layoffs for nursing and other staff as well as complex merger negotiations with the Toronto Western Hospital and the Princess Margaret Hospital. Changing the hospital=s name to University Health Network B General Division signifies the transition from its historical institutional identity as a general hospital to its twenty-first century incarnation as an internationally recognized research and treatment centre for cardiac and cancer patients. Like its single-storey predecessor whose focus was the sick but deserving poor, the University Health Network reflects the values of the society in which it functions. The enduring value of well-written institutional histories such as Doing Good lies in their ability to enable readers from a variety of different disciplines or perspectives to see how vital social functions have developed. Health care is currently of great interest to the Canadian public, and this book demonstrates the pivotal role that local hospitals have played in shaping provincial and national health policy at the same time as they are meeting individual=s health needs. For nearly two centuries, the doctors, nurses, administrators, board members, and patients of the Toronto General Hospital have been participating in the transformation of medical practice, medical education, and society=s values, and this book effectively illustrates how human passions, intellectual curiosity, business acumen, moral beliefs, and municipal, provincial, and federal politics intersected to shape those changes. (HEATHER MACDOUGALL) James E. Moran. Committed to the State Asylum: Insanity and Society in Nineteenth-Century Quebec and Ontario McGill-Queen=s University Press 2000. x, 226. $70.00, $27.95 James Moran has provided a valuable, well-written book on the history of asylums and insanity in Ontario and Quebec. In a jargon-free but theoretically informed analysis, Moran addresses a number of historiographical debates in the international literature. His main topic, the forces that shaped the early development of asylums, is a long-standing concern of historians of psychiatry. Through a close study of committal records and asylum 424 letters in canada 2001 university of toronto quarterly, volume 72, number 1, winter 2002/3 correspondence, Moran shows that the institutional history of insanity differed from Ontario to Quebec, and that this variance was a product of complex interrelationships among the state, early psychiatrists, local authorities, and families. As in other Western jurisdictions, asylum building in the colonies came from a deep and widespread belief in the power of institutions to promote and restore order in the individual and in society. Moran shows that the state-funded asylum in each colony was promoted by the imperial government, local officials, and professional elites, and eagerly awaited by families desperate for relief from the disabling affliction of insanity. Despite this consensus on its worth, conflicts came from competing ideas of the asylum=s proper function. For example, medical superintendents argued that the publicly owned Toronto asylum should be reserved for the curable and deserving. They fought, often successfully, to exclude the chronic and dangerous insane, the very people that local communities and families wanted to commit. However, local doctors and magistrates continued to certify candidates for the asylum based on social behaviour and economic considerations rather than on medical criteria. Moran describes the temporary asylum of the 1840s and the short-lived asylum for the criminally insane in the 1850s to illustrate how institutions embodied clashes and consensus between medical and lay expectations. In contrast, the story of the Beauport Asylum of Quebec illustrates a second complex set of power relations in which...