Mental illnesses have not always been treated the way they are today. Even with scientific progress, we still know little about what causes a number of illnesses. Contrarily, treatments to improve patients’ quality of life have improved remarkably over the years. But if we go back a few centuries, the situation was quite different and people had different values and ideas about life.
In the 17th and 18th centuries, little or nothing was known about the causes of madness; it was often confused with criminality. Scientists at the time did not agree on whether mad people were possessed by the devil, causing them to have intermittent fits of madness, or if there were physical causes of these states of mind. Whatever the case, there were three choices in those days for the confinement of mad people: a hospital, a prison, or a lodge, which only existed in Quebec. But the purpose of each was the same: to hide from view the undesirable elements in the Quebec City area and eliminate begging in its streets. It was to decrease begging that the Hôpital Général de Québec was founded in 1629, and institutions of the same kind were built in Montreal and Trois‑Rivières.1 It was only in 1714 that there were places for confinement of women, the “maisons de force”, and in 1721 “lodges” were created for men. These forms of confinement offered patients neither cure nor treatment. Their primary function was to control dangerous mentally ill people and to help families that could not afford to look after these patients. It was in 1801 that the first legislation concerning funding for confinement of the mentally ill appeared. Now that there was government funding, confinement in the lodges burgeoned and they were filled to capacity. In these lodges, the only method used at the time to treat patients in crisis was restraint, with the patient’s limbs being completely immobilized.
In Europe, those who attributed madness to purely physical causes developed other techniques whose effectiveness was more than doubtful. For example, spinning machines were a method used to “cure” madness. The patient was tied to a chair and was spun about for hours, even days. This technique was used to cause the blood to go to the brain and cause nausea, which it was said had beneficial effects. The surprise bath was another treatment of this kind, as was the iron cage, which isolated the patient during an acute attack and controlled his or her movements.2
Things began to change for these unfortunates in about 1793. A French doctor named Philippe Pinel developed a new theory that rejected the ideas about madness that existed in society. Pinel advocated giving up violent therapeutic treatments such as the iron cage or spinning chair in favour of calmer, more humane methods, such as moral treatment. Classification of mental illnesses began at that time. Pinel’s classification of mental illnesses, which he developed in the early 19th century, divided mental illnesses into four categories: melancholia, mania, idiocy and dementia. For a long time, this categorization of illnesses was the only reference used in the field of psychiatry.But in the late 19th century, three types of mental disorders replaced Pinel’s classifications: general paralysis, which included all complications of tertiary syphilis, alcoholism (withdrawal, psychoses, intoxication, alcoholic dementia), and schizophrenia. This was the infancy of the science of mental health: psychiatry.
In 1824, a report on the mentally ill in Lower Canada was presented to the Government as part of a movement towards removing the responsibility for the mentally ill from the Church and the religious orders.3 Doctor James Douglas, a well-known doctor in the Quebec area, gave a talk at this time on the causes of madness, which he attributed not only to heredity, but also to the socio-economic and socio-cultural aspects of the times. This view of madness led to a new idea: it could strike anyone, and being placed in a respectable establishment, in addition to providing more control over the patient’s bad habits, could have positive consequences for the individual. The Government accordingly asked Doctor Douglas to found an asylum in Quebec, which would be publicly funded. But Doctor Douglas worked towards a goal different from “confinement” of the mentally ill – moral reform of patients. His view was that isolation and locked, passive incarceration could only make the madness worse and, in some cases, lead to suicide. Isolation then gave way to community life; violence to calm and gentleness; bread and water diets to good meals; and so forth, all with the aim of moral education of the patient.4
Thus, on September 15, 1845, the Asile provisoire de Beauport (today l'Institut universitaire en santé mentale de Québec) was founded by Doctor James Douglas, with the assistance of doctors Charles-Jacques Frémont and Joseph Morrin. It was located in the former manor house of Sieur Robert Giffard, Seigneur de Beauport, pioneer and first doctor in New France. When it opened, 95 “lunatics” – the term used at the time for the mentally ill – were removed from hospitals and prisons in Quebec City, Montreal and Trois-Rivières and housed in the asylum. This was the first time it was considered that lunatics had an illness and were therefore curable.5 The humaneness of Doctor Douglas’s new therapies also led to some changes being made in certain shock treatments that people believed in at the time. This was the case with shower baths, where patients would be placed in a tank for about fifteen minutes and have cold water poured over them, and also with blood-letting from the head, the use of leeches, mercury, and so forth. They were still attempting at that time to cure patients with dizziness and vomiting. Confinement and isolation were still used for violent cases.6 These treatments were gradually abandoned, thanks to Doctor Douglas’s gentler treatments.
This era was therefore characterized by the fact that the authorities of the time became aware that the treatment of mad people was outdated and barbaric, and the first asylum in the Province was created in 1845 in Quebec. Change could be seen in the treatments given to the mentally ill, but especially in people’s ideas about mental illness, with Pinel’s theory, which would be applied at the Asile provisoire de Beauport from the time it was founded – moral treatment.It is also of note that in 1885, medical control of institutions in the field moved into the hands of the Government.
- Since its beginnings, l'Institut universitaire en santé mentale de Québec has had several different names: 1845-1850: Asile provisoire de Beauport; 1850-1865: Quebec Lunatic Asylum; 1865-1912: Asile des aliénés de Québec; 1912-1923: Asile Saint-Michel-Archange; 1923-1976: Hôpital Saint-Michel-Archange; 1976-2009: Centre hospitalier Robert-Giffard.
- Normand Séguin, s.d., L’institution médicale. Les presses de l’Université Laval, Québec, 1998. p. 37
- Archival collection, Galerie Historique Lucienne-Maheux, l'Institut universitaire en santé mentale de Québec.
- Hubert A. Wallot. Entre la compassion et l’oubli: La danse autour du fou, Survol de l’histoire organisationnelle de la prise en charge de la folie au Québec depuis les origines jusqu’à nos jours, I- La chorégraphie globale. Éditions MNH, Beauport, 1998, p. 30.
- Louisa Blair. Les Anglos : La face cachée de Québec, Tome I : 1608-1850. Commission de la Capitale nationale du Québec and Éditions Sylvain Harvey, s.l., 2005, p. 88.