Lesson 1: Care and Treatment

Starter: Treatment and Choice (5-10 minutes)

• In 1845 the Centre Hospitalier Robert-Giffard was opened in Québec City to treat “lunatics” – the term used at the time for people with mental health difficulties.  Show students pictures of the institution and of work therapy (late 19th/early 20th century), the straight jacket (19th century) and insulin therapy (20th century.) (RESOURCE 1A)
• Ask the students to write down how each form of therapy shown in the pictures could potentially pose human rights issues. How might choice or lack of choice have operated? What do you think was attractive about each one of these therapies for doctors and people running mental health institutions?

Discussion: Mental Health Treatments in the Past (20-30 minutes)

• Using RESOURCE 1A, explain to students that mental health treatments have varied over time. Dr James Douglas, the doctor who founded the Centre Hospitalier Robert-Giffard, believed that mental difficulties were a treatable illness caused by life circumstances and could be cured by humane treatment. This were radical ideas at the time, and meant that established treatments like cold shower baths, blood-letting from the head, and the use of leeches and mercury were not used in the Québec institution. These pictures represent three forms of “therapy” that were used in the past at Robert-Giffard and other Canadian mental health institutions:
• Work Therapy: It was believed that work was an excellent form of therapy and the ability and willingness to work was regarded as a sign of good health. From the 19th century, most institutions relied on the free labour of patients to operate. Women, like those in the picture, did laundry and cleaning, while men worked on asylum farms and in institutional construction projects. The idea that work can be therapeutic is key to the practice of occupational therapy today.
• Straight Jacket: Violent or rebellious patients might be tied down or locked in solitary confinement. This was a kind of “negative therapy” and was meant to encourage cooperation and good behaviour. Seclusion continues to be used today.
• Insulin Coma Therapy: One of a collection of “shock therapies” which included Electro Convulsive Therapy (ECT), insulin therapy was developed in the 1930s and used throughout the 1940s and 1950s in Canada and elsewhere in the western world. It was believed to help people who had been diagnosed as schizophrenic. Repeated insulin overdoses would put a patient into a state of coma for several weeks. Replaced by pharmaceutical remedies, insulin therapy is no longer used today.

Care and Treatment Today

• Today, the best treatment is usually a combination of treatments. Most people with mental health difficulties live in the community where they may receive a range of treatment alongside peer and professional support. This community care model can include individual therapy, group therapy, medications and other treatments such as meditation, traditional Chinese medicine, exercise, and message therapy.

Activity 1: Past and Present Treatment  (20 minutes)

• Have the students complete a mini jigsaw activity around current and historical forms of treatments – Two groups, one for current and another historical. (RESOURCE 1B)

Activity 2: Patient Experiences of Therapies (20 minutes)

• Have the students adopt the position of patients/users/survivors to explore the experience of different therapies that are the subject of the following article excerpts, patient writings, artwork and poetry. (RESOURCE 1C) Because these resources are drawn from historical and current sources, they demonstrate changing treatments and experiences.
• Ask students to reflect on the difference between patient experiences of treatments from the 1970s and 1980s and more recent accounts. Have students find a date for their patient piece, and then ask them to write a list of descriptors that they think best convey patient experience of therapy as illustrated in their resource. Discuss what changes the students found over time. What stays constant?

Activity 3: Treatments & Rights (30 minutes)

• Share with students the historical photograph of a late 20th century demonstration against forced treatment, a cartoon and/or a graphic from patient/user/survivor publications from the 1970s and 80s.(RESOURCE 1D) Explain that historically and today, the right of mental health patient/users/survivors to determine their own treatment has been a critical and controversial issue. These documents reflect protest through the 1970s and 1980s about treatment without consent, particularly the use of Electric Shock Therapy (ECT).
• More recently, Community Treatment Orders (CTOs) have been made legal in parts of Canada and elsewhere, requiring people living in the community to follow treatment, care and supervision regimes or risk being readmitted to hospital. Although CTOs are only meant to apply to those with serious mental health conditions, some argue this is forced treatment and a violation of human rights. (ADDITIONAL RESOURCES)
• Divide students into groups of three or four. Assign each group an article. (RESOURCE 1E)
• Have each group read and summarize the article answering the following questions:
  • What is the date of publication?
  • What are the main issues or concerns brought forward in your article? Where do rights and treatment come together?
  • Who are the principal people and/or organizations involved? From whose point of view is the story told?
  • What are the implications for people involved? For people with mental health issues? Health care providers? Family members? The community? And perhaps adopt the position of patients/users/survivors, practitioners, family members etc in discussion of these implications.
  • Provide any additional comments you have on the article.
• Bring the students back together and have each group share their article and findings with the rest of the class, perhaps with different students representing the points of view of different “stakeholders”.
• Discuss with the class their overall impressions about the issues surrounding treatment strategies used in the past. How is it different to the present? How much has changed?

Extension Activity: The Wall

• The site of Toronto’s Centre for Addictions and Mental Health is the former Toronto Insane Asylum, a vast mental health institution dating from the middle of the nineteenth century. Psychiatric survivors argue that the remaining patient-built walls are a testament to the lives and un-paid labour of former inmates and should be preserved as important historical landmarks in the community.
• Students and teachers can find out more about the campaign to gain acknowledgement of this historical site by following these links:
• http://www.youtube.com/watch?v=-5J_b6o59s8 http://www.camh.net/News_events/Redeveloping_the_Queen_Street_site/History%20of%20the%20Queen%20Street%20Site/heritage_wall_details.html
• http://www.psychiatricsurvivorarchives.com/wall.html

Closure:  (5-10 minutes)

• • Have students reflect on what they have learned about mental health treatment. What was something they learnt today that they thought was interesting or didn’t know before about how people diagnosed with mental health conditions have been treated?

 

Resources

1A Mental Health Treatments in the Past – photo collection

• Centre/hospitalier Robert-Giffard where the treatment photographs were taken.
• Insulin therapy
• Straight jacket
• Work therapy
• Students and teachers interested in further information about treatment and the Centre hospitalier Robert-Giffard can visit the Robert-Giffard Collection in the Archives of the History of Madness in Canada website.

1B Past and Present Treatment

• Mental Health Treatments over Time

1C Patient Experiences of Therapies

• “Downers,” article, In a Nutshell, 1978, 6, 3.
• “ECT Atrocities,” letter, In a Nutshell, 1976.4.1.
• Lara Gilbert, diary entry, 14 November 1994.
• Lara Gilbert, diary entry, 6 October 1992.
• “Shock,” graphic, In a Nutshell, 1976, 4, 1.
• “A Case of Knowing Yourself,” personal story, Phoenix Rising, 1985, 5, 1.
• Insulin Shock – Personal Account. www.psychiatricsurvivorarchives.com/people2.html
• Lara Gilbert, diary entry, 10 May 1992.
• Cartoon, Phoenix Rising, 1983, 3, 4.
• “Fruit is where you find it,” poem, In a Nutshell, 1979, 6, 4.
• “Patients Please,” poem, In a Nutshell, 1983, 8, 1.
• “Chlorpromazine,” poem, In a Nutshell, 1979, 6, 5.
• “Nurse listen to me,” poem In a Nutshell, 1978, 6, 2.
• “Open House at the Harbour,” poem, In a Nutshell, 1977, 5, 4.
• “Ridelen,” cartoon, In a Nutshell, 1976, 4, 2.
• “People: David Petterson,” personal story, Phoenix Rising, 1981, 2, 2.

1D Treatment and Rights Graphics

• ECT demonstration, photo, Phoenix Rising, 1986, 6, 2.
• Drugs Imagery, graphic, In a Nutshell, 1978, 6, 1.
• Medicated patient, cartoon, Phoenix Rising, 1983, 3, 4.
• “Abria Blum,” cartoon, Phoenix Rising, 1980, 1, 3.

1E Treatment and Rights Articles

• “Buying a Pill,” article, In a Nutshell,” 1978, 6, 1.
• “Phoenix Pharmacy: Ritalin,” article, Phoenix Rising, 1981, 2, 2.
• “People Drugged Against Will, article, Phoenix Rising, 1981, 2, 2.
• “Nozinan,” fake ad, Phoenix Rising, 1987, 6, 4.
• “Shock and the Law,” article Phoenix Rising, 1985, 5, 2.
• “Women’s bodies, men’s decisions,” article, Phoenix Rising, 1981, 1, 4.

Additional Resources

• The Annex Farm, 1885-1976 – at the New Brunswick Lunatic Asylum – work therapy in the institutional setting 
  
• Canadian Mental Health Association – Community Committal –  A thoughtful, fairly balanced piece by the Canadian Mental Health Association discussing Community Committal, or Community Treatment orders. It would be useful to have students read relevant sections and compare to the historical material listed above.

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