Moral Treatment and Nursing School: The Impact of Dr. Charles Kirk Clarke at Rockwood Asylum.

Clarke strongly believed in “moral treatment”, an approach to mental health based on humane treatment as well as scheduled days in a calm environment.

August 13, 1885. Dr. William Metcalf, medical superintendent of Rockwood Asylum and his assistant, Dr. Charles Kirk Clarke, are making their usual morning rounds of the institution. They approach one of the property’s cottages, where a patient suffering from paranoia attacks them with a knife. Dr. Metcalf is stabbed and dies three days later. Dr. Clarke accepts the superintendent position upon the death of his colleague, and spends the next twenty years at Rockwood, forever changing both the institution and practices in the Ontario Asylum System.

Dtr. Krirk
Dr Charles Kirk Clarke as Dean of Medicine, University of Toronto. 1914, Courtesy of University of Toronto Archives and Records.

Charles Kirk Clarke was born on February 16, 1857 in Elora, Upper Canada (now Ontario). After graduating from high school, Clarke began work in the psychiatric field immediately, first as a clinical assistant at the Asylum for the Insane in Toronto in 1874[i]. After graduating from the University of Toronto with his medical degree, Clarke was appointed assistant medical superintendent of the Hamilton Asylum in 1880. In 1882, he took the same position at Rockwood under the supervision of Dr. Metcalf. The two men had similar views on how an asylum should be managed, and worked together to abolish the use of restraints, and to “humanize” the institution by providing better living conditions and treatment plans, more nutritious meals, and occupational therapy.[ii]

After Metcalf’s untimely death, Clarke would continue to develop the dream he shared with his predecessor of enacting change at Rockwood. One of the first and most transformative actions occurred in 1888, when Clarke founded the Rockwood Training School for Asylum Nurses. This school was the first training program for psychiatric nurses in Canada.  By the time Clarke left the institution in 1905, the school had grown to include 122 lectures on various topics, and was graduating nurses every year, many of whom would go on to hold leadership positions in medical facilities across the country.[iii] The inclusion of trained nurses on the wards allowed for patients to receive around the clock care, instead of simply being supervised by untrained attendants, still a common practice in many asylums of the time period.

Nurses
First Graduates of a Mental Hospital Nursing Program in Ontario, Rockwood Hospital Training School for Nurses, 1890. Courtesy of KPH Historic Collection on loan from the Archives of Ontario to the Providence Care Hospital Archives.
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1880’s Style Reproduction of Rockwood Asylum Nurses Uniform. Courtesy of the Museum of Health Care.

Clarke strongly believed in “moral treatment”, an approach to mental health based on humane treatment as well as scheduled days in a calm environment. Moral treatment stressed the importance of nutrition, a balance of work and rest, exercise, and recreational activities to facilitate healing.[iv] Using this framework, Clarke revamped Rockwood into  an institution where most inmates held a job, took daily exercise either on the spacious property or in a purpose built hall, and took part in amusements such as yacht trips, music classes, and dances. These practices were gender separated and followed typical ideologies of the nineteenth century: male patients worked outside, whereas female patients were responsible for cooking, cleaning and sewing, essential functions for the asylum to run.[v] These vital chores meant female patients had less time to enjoy recreation, and therefore did not receive the same balanced day as their male counterparts. Nineteenth century women were still expected to be caregivers, even in a hospital setting.

Clarke built a separate infirmary at Rockwood for the physically ill, personally conducted a patient orchestra, and repeatedly petitioned the government to build a nurses’ residence on the property (which they finally did in 1904).[vi] Although positive changes continued to be made in Clarke’s time at Rockwood, he was unimpressed with the government’s seeming deafness when it came to his requests for the removal of the “criminally insane” from the institution, the lack of training for male attendants, and the continued use of the warrant system (the easiest way to ensure a relative would go to Rockwood for care was to imprison them at a local jail). Dr. Charles Kirk Clarke left the institution in 1905 due to his displeasure over asylum politics.

dr. kirk

Dr. Charles Kirk Clarke, ca. 1885. Courtesy of KPH Historic Collection on loan from the Archives of Ontario to the Providence Care Hospital Archives

After leaving Rockwood, Clarke continued to exert influence within the medical community. He accomplished much in the later half of his life, notably founding the Canadian Hospital Association in 1907, acting as Dean of the Faculty of Medicine at the University of Toronto from 1908-1911, and becoming Medical Director of the Canadian National Committee for Mental Hygiene in 1918. Clarke acted as a mentor for the many members of the next generation of Canadian psychiatrists, some of whom referred to him as the “Father of Canadian Psychiatry”.[vii] Clarke passed away in 1923, after spending more than half a century working tirelessly to make his thoughts heard and his vision a reality.

 


About the Author : Victoria Bowen

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Victoria Bowen is the 2019 Margaret Angus Research Fellow. Victoria recently finished her undergraduate degree at Queen’s University, and will be returning to Queen’s in the fall to begin her Master’s in Art History. This summer, Victoria will be developing a manuscript that examines Rockwood Asylum in the late nineteenth century, focusing on the impact gender had on the experiences of patients at the institution. 

Citations

[i] Ian Dowbiggen, “Clarke, Charles Kirk”, Dictionary of Canadian Biography, accessed June 02, 2019. http://www.biographi.ca/en/bio/clarke­_charles_kirk_15E.html.

[ii] Bruce R. Thomson, 125 Years of Keeping People Healthy (Produced by the Kingston Psychiatric Hospital, April 1981): 14.

[iii] Ontario Inspector of Prisons and Public Charities, Annual Report of the Medical Superintendent of the Asylum for the Insane, Kingston for the Year Ended 30th September 1903 (Toronto: Warwick and Sons, 1904): 56, accessed June 07, 2019, https://archive.org/details/annualreport36onta/page/n2.

[iv] Terbenche, Danielle. “Curative and Custodial: Benefits of Patient Treatment at the Asylum for the Insane, Kingston, 1878-1906”, The Canadian Historical Review 86:1 (2005): 33, accessed May 15, 2019. DOI: https://doi.org/10.1353/can.2005.0091.

[v] Terbenche, 38.

[vi] Ontario Inspector of Prisons and Public Charities, Annual Report of the Medical Superintendent of the Asylum for the Insane, Kingston for the Year Ended 30th September 1904 (Toronto: Warwick and Sons, 1905): 68, accessed June 07, 2019, https://archive.org/details/annualreport37onta/page/n2.

[vii] Dowbiggen, Clarke.


Bibliography

Dowbiggen, Ian. “Clarke, Charles Kirk.” Dictionary of Canadian Biography. Accessed June 02, 2019.                 http://www.biographi.ca/en/bio/clarke_charles­_kirk_15E.html.

Ontario Inspector of Prisons and Public Charities. Annual Report of the Medical Superintendent of the    Asylum for the Insane, Kingston, for the Year Ended 30th September 1903. Toronto: Warwick and              Sons, 1904. Accessed June 07, 2019. https://archive.org/details/annualreport36onta/page/n2

Ontario Inspector of Prisons and Public Charities. Annual Report of the Medical Superintendent of the    Asylum for the Insane, Kingston, for the Year Ended 30th September 1904. Toronto: Warwick and              Sons, 1905. Accessed June 07, 2019. https://archive.org/details/annualreport37onta/page/n2

Terbenche, Danielle. “Curative and Custodial: Benefits of Patient Treatment at the Asylum for the           Insane, Kingston, 1878-1906.” The Canadian Historical Review 86:1 (2005): 29-52. Accessed May     15, 2019. DOI: https://doi.org/10.1353/can.2005.0091.

Thomson, Bruce R. 125 Years of Keeping People Healthy. Produced by the Kingston Psychiatric Hospital,                April 1981.

 

 


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