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Clarke Institute of Psychiatry
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The Clarke Institute of Psychiatry, located at 250 College Street in Toronto, Ontario, was officially opened by Premier John P. Robarts of Ontario on May 18, 1966, although no patients were admitted until July 1, 1966. On the latter date the service, educational, and research functions of the Toronto Psychiatric Hospital (1925-1966) were taken over by the Clarke Institute, to be developed there in a new, modern environment as provided under a University-Institute agreement. A more arms-length relationship to the provincial Health Ministry came via the creation of a governing Board of Trustees, established under the Ontario Mental Health Foundation Act of 1964. The Institute, as the main teaching hospital in Psychiatry for the University of Toronto, opened its doors as headquarters for the Department of Psychiatry in the Faculty of Medicine on June 13, 1966. The Institute was recognized as a public hospital under the Public Hospitals Act of Ontario. It boasted of education and research activities rooted in a comprehensive program of patient care, including services for children and adolescents and varying from outpatient treatments through in-patient care and emergency services. Ultimately the Clarke was one of four specialized institutions merged into the Centre for Addiction and Mental Health (CAMH) in 1998. Dr. Charles Roberts was the first Medical, and Executive, Director of the Clarke from 1966-1967. Dr. Aldwyn B. Stokes was the Clarke’s first Psychiatrist-in-Chief as well as, since 1947, Professor and Head of the Department of Psychiatry at the University of Toronto. In 1967, upon Stokes’ retirement and a reorganization of the senior administration of the Clarke, Dr. Robin Hunter, a psychoanalyst from Queen’s University in Kingston, Ontario became Medical Director and Psychiatrist-in-Chief. The 1965 agreement between the governors of the University of Toronto and the Clarke Institute stipulated that the Professor and Head of the Department of Psychiatry of the University would also be the Psychiatrist-in-Chief of the Clarke Institute. Thus, Hunter and his successors were also to hold this post within the Department of Psychiatry at the University. Dr. Frederick H. Lowy succeeded Hunter in 1974. Dr. Vivian M. Rakoff replaced Lowy as the Director and Chairman of the Department of Psychiatry in 1980 and his tenure lasted until 1990. Dr. Paul E. Garfinkel was Director and Chairman of the Department of Psychiatry from 1990, continuing in the latter capacity following the Clarke Institute’s merger into CAMH. The Clarke’s predecessor, Toronto Psychiatric Hospital (TPH), was located at 2 Surrey Place in Toronto and began admitting patients on December 18, 1925. TPH’s first director was Dr. Clarence B. Farrar, an American psychiatrist trained at Johns Hopkins University. Dr. Aldwyn B. Stokes, an English clinician, succeeded Farrar in 1947 and remained in his capacity until 1960, while continuing as Head of the university’s Department of Psychiatry. Dr. John Dewan was director from 1960-1964. TPH’s last director, Dr. Charles Roberts, presided from 1964 until TPH’s closure in 1966. TPH was the first real effort to bridge the gap between psychiatry and mainstream medicine. It became renowned for its contributions to psychiatric research, particularly in biological psychiatry. At a time when psychoanalysis and social theories of mental illness dominated elsewhere, the tradition of the belief in the essentially organic nature of mental illness persisted at TPH. Unlike other Ontario hospitals or general hospitals, TPH was premised on this tradition and celebrated for developing a new scientific approach to mental illness. The story of TPH is one of steadily expanding services. First, in 1926, came the outpatient department. Occupational therapy became a separate department in 1927. By 1932 over 80% of TPH inpatients received regular occupational therapy. The first social worker, Marion E. Stewart, also a registered nurse, was appointed in 1930. Psychology also began as a part of the outpatient department. Two-fifths of all cases admitted to TPH in the early years were referrals from the courts. From the beginning, teaching was an integral part of TPH’s role. Any history of TPH is of necessity also a history of the Department of Psychiatry of the University of Toronto. Instruction began in 1926, with lectures as well to fifth and sixth year students at the Queen Street hospital. The emphasis was on biological psychiatry and the relation of psychiatry to general medicine. Beginning in 1927, the hospital offered clinical courses and also introduced psychiatry during the fourth year of medical school. In 1928 Farrar established a weekly seminar on Saturday mornings called the Inter-hospital Psychiatric Society. This seminar was intended to increase the exposure of psychiatry and help establish it as a legitimate medical science. In 1931 a one-year postgraduate course was established for junior doctors of the Ontario Hospital Service. There were four two-hour staff conferences a week. In 1933 a Ph.D. in psychiatry was established by enrolling the Department of Psychiatry in the School of Graduate Studies. Throughout this period, TPH teaching programs received a good deal of financial assistance from the Rockefeller Foundation which helped to supplement the salaries paid by the Ontario Hospital Service and also helped TPH through the depression. The Board of Psychiatric Examiners was established in 1934; this helped to assure a higher and uniform standard for psychiatry. Until the late 1930s patient care was very limited. A new wave of physical therapies began in the late 1930s with the advent of the various shock therapies: insulin coma therapy, metrazol therapy and electroconvulsive therapy (ECT) as well as lobotomy (bilateral frontal leucotomy) beginning in 1941. The work suggested a definite somatic basis for mental illness. Furthermore, it established TPH as a center of biological psychiatry in a world leaning increasingly towards psychoanalysis. In 1947 an advisory committee on mental health was established. It was agreed that more psychiatric beds should be established in general hospitals, that community mental health clinics be extended, and that more public education was needed. This committee, and many others to follow, was a response to the severe overcrowding that developed in the decade after the war. In 1948 the federal government began funding psychiatry in Ontario through the National Health Program Grants. This enabled Dr. Stokes to expand the teaching staff and bring more postgraduate students from the Ontario hospitals. The enrollment in 1949-50 doubled over the previous year. A committee established in 1950 by Richard Montgomery, director of the Hospitals Division, however, concluded that there was an urgent need to improve buildings and clinical facilities available to the students. In 1949 a psychiatric unit in the Wellesley Hospital (from 1949-1960 the hospital together with the psychiatric unit was administratively part of TGH) was set up where Dr. Stokes had admitting privileges. This move effectively expanded the facilities of the TPH and provided the first bridge between the Department of Medicine (neurology) and the Department of Psychiatry. This was part of the larger move towards the integration of psychiatry with mainstream medicine and the model soon expanded to other teaching hospitals. By the end of the 1950s, 11 hospitals and institutes were affiliated with the Department of Psychiatry for clinical teaching, while centralized courses were given at TPH. As well, a growing emphasis on psychoanalysis was particularly apparent in the curriculum at TPH. A children’s clinic was established in 1947, but not until 1959 was a separate children’s service established under Edward Rosen, as part of a two-year graduate course in child psychiatry. Many new services were also allied with community agencies and programs. Also in the 1950s TPH stressed an informal, open-door policy. Mental illness was now regarded as a breakdown in living, and treatment centred on readjusting people to society. In 1949 the Forest Hill Project, a five-year study of the mental health of school children in a community was begun. The study was the first major psychological research project undertaken in a Canadian community. It focused on the emotional adjustment of school children by examining all aspects of their life in a community. As well, there was work done on group dynamics, group therapy, psychometrics and speech pathology. A metabolic clinic and laboratory was set up at TPH in 1947 for the famous visiting Norwegian psychiatrist Rolv Gjessing. Gjessing’s arrival brought instant international recognition to the hospital. In 1952 Stokes brought Dr. John Lovett-Doust, an expert in physiological psychiatry, from London. Lovett-Doust initiated a program of biochemical and physiological researching and also headed the drug research laboratory at TPH. By the 1950s both the population of Ontario and the services of the hospital had grown beyond all original estimates. A new psychiatric institute was one of the priorities of the 1951 Health Survey Committee Report. The Borden Committee concluded that plans should go ahead immediately for a new Ontario Psychiatric Institute on a site near the University of Toronto and other hospitals. The new hospital was to be run by a board of trustees and financed by the province. After years of delays, the way was finally cleared in spring of 1963. The cost was given at $6.6 million. In the end, forty percent of funded psychiatric research in Ontario was done at the Clarke. Dr. Frayn reports that by 1996 the Institute had trained half of the psychiatrists in Ontario and one-quarter of the psychiatrists in all of Canada. Known post-merger as the College Street Site of CAMH and continuing as the headquarters of the University’s Psychiatry Department, this facility is now slated for an eventual amalgamation with all four CAMH sites onto what is planned to be a substantially redeveloped version of the Queen Street Site. Selective bibliography: The Clarke and its Founders: The Thirtieth Anniversary by Douglas H. Frayn. Coach House Books, 1996. From Vision to Legacy by Honey Fisher. CAMH, 2000. Psychiatry in Transition 1966-1967, edited by Aldwyn B. Stokes. University of Toronto Press, 1967. TPH: History and Memories of the Toronto Psychiatric Hospital, 1925-1966, edited by Edward Shorter, especially “The Life of the Toronto Psychiatric Hospital” by Roger Baskett. Wall and Emerson Press, 1996.