My "asylum" experience continues: Part 2

Here's Part 1.

I've written only about the women's ward in the psychiatric institution called the Verdun Protestant Hospital but part of our group also worked on the men's ward. I have no real impression of what their work was like. In a way, there was such a feeling of intimacy with some of our patients on the women's ward, I wonder what could possibly duplicate that feeling on the men's ward? We were warned of — and experienced — dangerous situations with the women so I can only imagine what it must have been like working with the men.

I do remember that our whole group — and maybe some other groups — were taken on a chilling tour of the locked ward where the most dangerous patients were kept. These were people who had come through the criminal justice system, who had been charged with serious violent crime and who had been found not guilty by reason of insanity. This was maximum security; we were accompanied by a contingent of security staff and doors were unlocked and re-locked as we approached and passed through.

It was scary and sad and it was also a bit mesmerizing, in the way of a horror movie.

When I was looking up a few facts about the Verdun hospital, I came across a survey that had been done in 1937, detailing the state of the hospital, the staff, the patients, the food, the dress, the recreation, the care. It makes for interesting reading and although I'm sure many of the changes that it recommended had been implemented by the time we came along, there were some descriptions that sounded very familiar.

Without enumerating the details of all the wards, certain general remarks may be made. As has been stated before, there is very serious overcrowding in all of the wards devoted to public patients, and at least one ward now in use, namely "A" and "Observation", which is located in the basement, is not at all suitable for the care of patients.

In spite of that fact, 70 male patients, of various types, are housed there at present. The beds are crowded much more closely together than should be the case, with the result that the ventilation which even under ideal conditions of ward population would not be entirely satisfactory, is decidedly inadequate.

So far as could be observed, the housekeeping was reasonably good. The beds were clean and in spite of the woeful lack of bathing facilities, the patients appeared clean and the wards in general were free of odor. The natural lighting of a number of the wards is poor, and the arrangement is such that adequate supervision of the patients could not be obtained without a large addition to the personnel.

It's so polite and tactful, isn't it?

I think the main impression that comes across in the survey is cheerlessness and that's definitely one of the feelings I was always left with. My memory may not be terribly specific about the conditions in the hospital but my impression is that it was dank and dark and lacking in cheer and colour and hope.

At some point in our training, we were taken on a field trip to another "asylum" — the vast institution in the East End of Montreal called Saint-Jean de Dieu.

We went there on a bus and I remember being taken in by a back entrance to a sitting/waiting room until our guide appeared — a nun in full habit. Saint-Jean de Dieu, run by the Sisters of Charity, at that time housed over 5,000 mentally ill patients. I didn't know it then but I found out later that it was, in fact, an incorporated municipality and the Mother Superior was also the mayor. The hospital/town had its own police force, fire department, post office and its own polling stations during elections.

It also had shops and small businesses along its big main hallway — shoe repair, bakery, sewing and weaving — all operated by the patients. You couldn't help but think of that old observation that "the inmates have taken over the asylum" — but in a good way. I don't know how it looked to the patients and their families but to me it seemed bright and cheerful and hopeful. It was clean and well-lit.

That hospital was so big, it had a tramway inside to transport goods and patients from one place to another. Do you see the rails?

Most people remember — and she was memorable — the patient who believed she was Queen Victoria and dressed and behaved accordingly. She had a regal wave that Queen Elizabeth II would surely envy.

(This is the look she was going for.)

You can only conclude that the difference in the two hospitals was the presence of the nuns. There would have been a good population of nuns in Quebec at that time — this was still pre-Quiet Revolution — and nursing nuns were dedicated to service and to their patients. The survey I mentioned above about the Verdun centred in so many areas on lack of personnel.

I learned a lot from comparing these two settings.

We did eventually get back to the Montreal General and it was like leaping ahead a couple of centuries. I'll come back and tell you about that.

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Here's Part Three.

Incurably insane to treatable psychotic: my asylum experience

There are times I look back on the psychiatric training we Montreal General students got just after the middle of the last century and wonder if we somehow fell into the Middle Ages. We were right on the cusp of some major changes but we were still in a time when the hospitals were called asylums and some of our mentally ill patients still had the diagnosis "incurably insane" written on their charts.

It was the early 1960s, but a couple of those patients had been admitted to the hospital back in the '30s and I think there was one — her name was "Baby" — who had been there since the '20s. I think she had been admitted as a teenager after being accused of killing someone. (I'm saying "I think" quite a lot here because it was a long time ago and the nature of some of the memories I have are almost dream-like.)

Our hard-core psychiatric work — I'm not sure I can honestly call it "training" — was done at what was then called the Verdun Protestant Hospital. It's now called the Douglas Mental Health University Institute. We referred to it only as "the Verdun" and my memories of it — of the actual hospital — are spotty. I remember the large grounds, with laid out walkways, because we were allowed to take certain patients outside for walks and I remember it being pleasant out there.

If this is how the hospital looked, this would have been much earlier than my time. I can see it being like this however, before those trees matured.

Dr. Heinz Lehmann, who became very well-known for his work in psychiatric drugs, was director of the Verdun and in some of my reading, I see that he described the hospital before some of the big changes that were to come, as a "snake pit." Oh yes.

I worked on the women's ward. Most of the women had been there for years, some for decades. When we had some spare time, we could go into the record room and read some of the charts. There were thousands and thousands of pages written about each patient although we were astonished to discover that some of the charts had ended years before. It was as if there was nothing more to say.

Some of the patients were harmless but we were warned that most had a very dangerous side. A couple of them, we were cautioned, were cleverly manipulative and they would behave almost normally around us, smiling, being helpful and conversational. The more experienced among us watched carefully because those patients regularly attacked young nurses after lulling them into feeling secure. It didn't happen to me but I saw it happen once; it was horrible and involved alarms going off, burly men appearing on the scene, our patient being held down (not easy, even for the burly men) and a vast amount of a tranquilizing injection administered under indescribable duress.

It was scary and I realize, looking back, that there were a lot of things to be scared of there. We had to go through a tunnel to get from our residence to our work. That tunnel was awful and if we ever found ourselves alone down there, it was a nightmare. We did try to stick together.

It was surely a stressful place to work but there were pleasant times too. Some of our patients were adorable, child-like almost (I guess we would be too if we'd been there for so many years, being treated like a child), wanting approval and loving hugs and hand-holding.

There were two patients called Tilly. One was Tilly the White Rabbit who had been walking hurriedly up and down the same small piece of hallway all her waking hours for many years. She had worn a groove in the floor.

Tilly the Police Officer walked purposefully around the ward, not looking as if she were noticing anything but in fact, aware of every little detail of what everyone was doing. If we needed to know something about one of the non-communicative patients, Tilly was our woman.

But we always had to be careful. There was one patient, much much bigger than I, who liked to wrap young nurses in a bear hug. She got me in her grip one day and wouldn't let me go. I quite literally couldn't move and could barely breathe. I tried talking to her calmly, saying everything we'd been taught to say, but I finally had to yell for help. It caused quite a crisis on the ward. She was a difficult patient and she clearly enjoyed having the upper hand. I was never sure after if she remembered having done that. That was scary in itself.

Our patients — as far as I know, looking back — were psychotic and they were being treated with massive doses of anti-psychotic drugs. I think this was a fairly new development and it was probably why the patients were able to function — in their own way.

The thing that got me thinking about all this was reading lately something that referred in passing to electro-convulsive therapy — which we were ordered to say — also known as "electric shock treatment" which we were ordered never to say.

Electro-convulsive therapy (ECT) and deep insulin coma therapy were both used at the Verdun but not so much on our ward. I think they must have been used in areas where the patients had a better prognosis. I only remember seeing the treatment once or twice but I do remember this: the shock was administered with no general anaesthetic and the thought of that is another kind of shock. (I assisted with ECT many times in the psychiatric unit back at the Montreal General where the second part of our affiliation took place and there, we did use general anaesthetic. It was still shocking — sorry, it just seems to fit — but a little easier to take.)

I was still a few years away from being able to look at the incarceration and treatment of the women at the Verdun with a feminist analysis. For Her Own Good hadn't even been written yet. That will be a subject for another time.

But I obviously have more to say about life in the asylum and being a nurse to the mentally ill so I'll be back with Part Two.

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Here are Parts Two and Three.