Managing Madness: Weyburn Mental Hospital and the Transformation of Psychiatric Care in Canada by Erika Dyck, Alex Deighton (review)

On December 29, 1921, a crowd gathered in the city of Weyburn, in the Canadian province of Saskatchewan, to celebrate the opening of the province’s second mental hospital. In Managing Madness historians Erika Dyck and Alex Deighton tell the story of twentieth-century mental health care in Canada through the prism of the Weyburn hospital. Whereas most asylums erected in the 1800s had already become warehouses of insanity by the 1920s, Weyburn recapitulated that century-long history within a few short years, and by the 1940s, “had the rather unenviable distinction of having the highest number of deaths in mental hospitals in relation to population for the whole country” (p. 88). Little wonder that Canadian sociologist Erving Goffman coined the phrase “total institution” after studying Weyburn’s living conditions.

Nonetheless, Weyburn was not just any mental hospital, nor was Saskatchewan just any political jurisdiction delivering mental health services in the twentieth century. Throughout the 1900s, Weyburn and Saskatchewan were also the sites of several cutting-edge reforms in mental health care. Weyburn “gained international recognition for making the most significant changes to mental health care on the continent” (p. 224). Most of the new treatments of the time—electroconvulsive therapy (ECT), insulin shock, lobotomy, and chlorpromazine—were used to one extent or another on Weyburn’s wards. Additionally, in the 1950s and 1960s, “the institution went through the most rapid, and arguably the most successful, down-sizing of a large mental hospital in the Western world” (p. 233).

But in hindsight, it was Saskatchewan’s experiment with psychedelic research and treatment that stands out. Psychiatrists Humphry Osmond (who coined the word “psychedelic”) and Abram Hoffer spearheaded testing of lysergic acid diethylamide (LSD) on themselves and patients. Dyck and Deighton are not exaggerating when they say that Saskatchewan researchers “contributed significantly to international developments” in mental health. The province’s “daring experimentation” in both general and mental health put Saskatchewan squarely on the psychiatric map (pp. 115–16).

Much of this psychiatric history played out against the backdrop of the election in 1944 of a Cooperative Commonwealth Federation (CCF) government under Thomas (Tommy) Clement Douglas. The CCF government, inspired by Douglas’s faith in scientific expertise and Social Gospel Christianity, proceeded to introduce North America’s first state-funded program of health services as well as an integrated health care system that combined reform along general and mental health lines. The trailblazing Douglas was willing to invest government funding in mental health treatment and research. The result was that, in the 1950s, Weyburn went from being one of the worst asylums in the world to enjoying the “status of a world-class institution” (p. 116).

Managing Madness contains fascinating glimpses into Saskatchewan’s psychiatric past. For example, architect Kiyoshi Izumi, on whose designs the Yorkton Psychiatric Centre was partly based, liked to wander the wards at Weyburn high on LSD in an attempt to visualize the hospital’s interiors as patients did (p. 110). In August 1967, a discharged psychiatric patient killed nine family members at a farm near Shell Lake, Saskatchewan. It was the biggest single mass murder in Canadian history until 1989, when a gunman murdered fourteen women at Montréal’s École polytechnique. The “Shell Lake Massacre” sparked a nationwide backlash against the policy of deinstitutionalization, which had been unfolding since the 1950s.

Dyck and Deighton conclude that Weyburn was neither a “total institution” nor the monument to suffering humanity its supporters claimed it was in its beginnings. The mental hospital was a “blunt instrument,” they write, “for managing extremely subtle and complicated sets of problems, only some of which were clinical.” Their thesis is that involving “consumers” in “meaningful decision-making roles” when it comes to planning mental health policy might lead to “a more nimble system.” That may in fact be a “first step” toward...