The word bedlam is used to describe a place or a situation of chaos or general craziness.
It actually comes from an insane asylum in medieval England. It was more like a prison than a hospital, and the patients received little in the way of actual treatment for their mental disorders. Yet, for generations Bedlam was the model for institutions for the mentally ill throughout the British Empire. A psychiatrist named Charles Kirk Clarke was largely responsible for revolutionizing the treatment of the mentally ill in Canada.
Born in Elora in 1857, Charles was the son of prominent parliamentarian Charles Clarke. He attended high school in Elora. Two of his sisters were married to psychiatrists, one of whom was the son of Joseph Workman, the superintendent of the Provincial Asylum for the Insane in Toronto. Through that connection, Clarke began work in 1874 as an assistant at the institution.
Meanwhile, he studied medicine at the University of Toronto and graduated as an MD in 1879. The following year he was appointed assistant medical superintendent at the Hamilton Asylum. He said the staff there were “an uncontrollable rabble.”
In 1882, Clarke joined his brother-in-law William Metcalf as a member of the staff at the Rockwood Asylum for the Criminally Insane in Kingston. At that time, the administrators of such institutions were usually political appointees – men with no qualifications for the job. Clarke didn’t have much regard for politics or politicians, though his father’s zeal for social progress and reform showed in the son’s desire for radical change in the treatment of the mentally ill.
Dr. Clarke would strongly denounce what he called “the malign influence of politics over psychiatry.”
Clarke and Metcalf both favoured reforms in the care of the insane, but their efforts were hampered by institutional politics. Clarke was about to resign out of frustration, when on Aug. 13, 1885, the two doctors were attacked by a knife-wielding patient. Metcalf died from his injuries. Clarke was offered the position of medical superintendent and decided to accept it, “to protect several hundred defenceless creatures from a political hireling who might be pitchforked into the position.”
Clarke was instrumental in making the institution more of a hospital and less like a prison. He supported the implementation of formal training for nurses and attendants.
He succeeded in gaining patients greater freedom of the institution’s grounds so they wouldn’t spend most of their time confined. And he explored the development of occupational and therapeutic activities such as handcrafts and participation in an orchestra. He made an eloquent plea for the abandonment of the word
“asylum,” which carried such a negative stigma. He said it was vital people realize “that an insane person is one suffering from bodily disease just as much as the patient with typhoid fever.”
Clarke was at the forefront of a rebellion against the traditional ways of treating mental illness, which generally were based on the belief that there was little anyone could do for mental patients except shelter them and look after their basic needs. Clarke and other progressive doctors felt mental illness could be treated and even prevented.
He was a pioneer of a budding science called mental hygiene, and laid the groundwork for the establishment of out-patient clinics for those who did
not require actual hospitalization.
Clarke didn’t agree with all of the new ideas that were being examined in the field of psychiatry, such as some aspects of Freudianism and what Clarke thought was its preoccupation with sex. He even agreed – although only temporarily – with the theory behind the pseudo-science called eugenics.
Clarke was one of the “radical” proponents of the argument that some criminals were insane and not responsible for their actions. He was called upon as an expert witness at numerous trials. Clarke was among those who said the Metis rebel leader Louis Riel was mentally ill and should not have been hanged, although he was not asked to appear at Riel’s trial.
Clarke almost lost his life one day while he was standing on the Rockwood institution’s dock. A patient suddenly seized him and plunged them both into Lake Ontario. Clarke struggled, but the patient was too strong. He was determined to drown himself and Clarke with him. Fortunately, another man saw what was happening and came to the rescue.
Clarke did not blame his assailant, but said the man had acted on an “irresistible homicidal impulse.”
In 1905, Clarke became superintendent of the Toronto Asylum. He found he had an ally in W.J. Hanna, the Provincial Secretary whose portfolio included the administration of mental hospitals. Clarke and Hanna decided that between them they could make Ontario the national leader in the care and treatment of the mentally ill.
In 1907, Clarke was a member of a committee that went to Europe to visit the major psychiatric clinics there. He was especially impressed with the clinic in Munich, Germany. Clarke wanted to establish a similar hospital in Toronto.
To his great disappointment, backroom political intrigues and the provincial government’s refusal to provide funding killed the project. Clarke wrote, “If such a Hospital is to be established, it must be kept absolutely free from political control … politicians will interfere where the chance opens itself; and the appointments to such an institution should be absolutely above suspicion; scientific attainment alone should be the qualification.”
Over the years Dr. Clarke accumulated an impressive body of qualifications and accomplishments: Commissioner for an inquiry into the British Columbia Provincial Asylum for the Insane, first Canadian associate editor of the American Journal of Insanity, honorary doctor of Law at Queen’s University, Dean of the Faculty of Medicine and professor of psychiatry at the University of Toronto, and superintendent of Toronto General Hospital.
During the First World War, Clarke established a ground-breaking clinic for the treatment of venereal diseases and organized a hospital unit that was sent overseas. He became a government consultant for the treatment of mentally ill war veterans.
Clarke died of heart failure in 1924. The Clarke Institute of Psychiatry in Toronto was named in his honour. The doctor from Elora is regarded by many as the father of Canadian psychiatry.
