Behind Asylum Walls: Studying the Dialectic Between Psychiatrists and Patients at Montreal’s Saint-Jean-de-Dieu Hospital during the first half of the Twentieth Century

Behind Asylum Walls: Studying the Dialectic Between Psychiatrists and Patients at Montreal’s... Summary Hospital archives contain traces of psychiatric patients’ words—written and spoken accounts that could be construed as delusional, irrational and poetic. How are these singular historical narratives, transcripts and letters, which are often out of the ordinary, to be addressed? The historian is tempted to write these psychiatric cases off as nothing more than colourful examples. However, as per French historian Arlette Farge, ‘to take this discourse and work with it offers an answer to the desire to reintroduce lives and individualities into the historical narrative’. This paper questions the ways histories of madness are read and written, based on the rare words of patients found in psychiatric archives. How do we analyse these unique traces of intercourse between experts and marginalised individuals? What do they reveal about power relationships or resistance? Which standpoint should be taken, in order to write history from below, given the challenges posed by the narratives and social positions of the actors involved? psychiatric institution, patient records, qualitative methodology, Quebec, twentieth century Dear friend [Dr Legrand] if one day my thougts my ideas my desires come true that woud make the heigt of my hapiness fulfiled dear friend away from you I cry and miss you and if the place lets us I Marie Louise will keep my love for you forever. At present the 25 pils you have prescribed for me have worked well and if you woud like to prescribe a box of them please I wil be able to continue for a wile taking 3 a day.1 The sometimes delirious, irrational and poetic statements and writings of psychiatric patients raise the question: How can a historical narrative based on these singular discourses, transcripts and letters, which often relate unusual events, be produced? The statements and written words of patients are difficult to analyse, as they are extremely rare and mainly recorded by others. Further, an analysis of word fragments found in clinical records must maintain distance from conventional perceptions of madness and psychiatry. Yet, with regards to these singular and possible lives, a researcher’s stance can be critical of psychiatric power, while also acknowledging the agency of institutionalised patients. The following exploration of the dialectic between psychiatrists and patients is based on fragments of sentences and conversations taken from medical records kept at Montreal’s Saint-Jean-de-Dieu Hospital during the twentieth century. A close reading of these records suggests that the patients’ writings clearly challenge the dominant theoretical predispositions of social history, including feminism, Marxism and social control. Far from remaining passive and dominated subjects, patients admitted to a psychiatric institution often make light of professional roles—doctor, psychiatrist, nurse—and, more particularly, of social norms. In this article, we will answer the following questions: How much of the emerging narrative results from the actor’s (patient’s) intended self-revelation, and how much stems from the researcher’s aim to tell the story? How can we negotiate this ambiguous and productive area of historical discourse using today’s theoretical and conceptual tools? Moreover, how are we to analyse these unique traces of intercourse between an expert and a marginalised, institutionalised individual? What do they tell us about power relationships and resistance? How do we write history while taking institutionalised persons into account, despite the challenges posed by the very discourse and social status of the actors concerned? In the following pages, we explore research avenues that illustrate the dynamics between learned actors (psychiatrists) and actors considered insane (patients) in three stages. We begin with a short introduction to the Saint-Jean-de-Dieu Hospital. Secondly, with the help of excerpts from the hospital’s medical records, we outline two possible methods of analysis used in our research. Finally, we discuss theoretical aspects of analysing traces written by oneself to others, and by others about oneself. Saint-Jean-de-Dieu Hospital, 1873–1950 The nineteenth century is known for the construction of vast, veritable asylums.2 In Lower Canada, the first asylum, the Montreal Lunatic Asylum, opened its doors in 1839, as part of the Pied-du-Courant prison in Montreal.3 Lunatics, melancholics, fools and the mad were committed for short periods of time up until 1845. When the Montreal Lunatic Asylum closed, the patients were transferred to the Beauport Asylum in the Quebec City area, the first permanent asylum in Canada. Beauport was organised along the lines of the Glasgow asylum in Scotland.4 It was thus set within a context of large-scale immigration from Britain, especially Ireland, of growing urbanisation and socio-ethnic conflict, of the economic crisis of the 1830s, and an upsurge of misery and destitution, that politicians and social experts started trying to manage deviant behaviours. In effect, the mad were increasingly perceived as people who put other members of society in danger, as much a result of their scandalousness as of their harmfulness. During the second half of the nineteenth century in Canada, two large asylums were built in the Montreal region: Saint-Jean-de-Dieu for the Catholics and the Protestant Hospital for the Insane for the Protestants and the Jews.5 The institution of interest here, Saint-Jean-de-Dieu, is located on the eastern part of the island of Montreal, and opened its doors in 1873 (Figure 1). Known today as the Institut Universitaire en Santé Mentale de Montréal (IUSMM),6 Saint-Jean-de-Dieu Hospital was, with its twelve large pavilions, host to 1844 patients in 1901.7 As such, an attempt was made to prevent chronic and incurable madness by establishing a system of early commitment, rather than simply relieving society of its mad people. The pool of behaviours associated with insanity was consequently broadened and the asylum population increased.8 Fig. 1 View largeDownload slide Photograph of Saint-Jean-de-Dieu Hospital in 1934 Source: Documents de la session parlementaire de la Province de Québec, 1935, 68, IV, 106. Fig. 1 View largeDownload slide Photograph of Saint-Jean-de-Dieu Hospital in 1934 Source: Documents de la session parlementaire de la Province de Québec, 1935, 68, IV, 106. While the majority of patients were committed for reasons of familial and social security, therapeutic approaches were being developed, and the 1920s saw changes in the methods of treating patients. For example, the hydrotherapy system was set up in 1921 and, the following year, a department with specialised personnel was devoted to occupational therapy. Around the same time, ‘doctors’ meetings’ were organised. These weekly meetings allowed the psychiatrists to collaborate, in order to better determine the diagnoses for new admissions. Patient examinations took place in three stages. First, notes were taken on the patient’s attitude, the way they walked, their clothes, smell, manners (if relevant) and their facial expressions.9 Next came an interrogation, based on about 20 questions, which allowed the doctors to evaluate the degree of orientation in time and space and sensory capacity of the patient. Based on the patient’s responses, the doctors determined their affectivity, memory, judgement and reactions, and whether they were suffering from delusions, hallucinations or conspiracy theories. Finally, the meeting concluded with an analysis of the information provided by the people who had requested the commitment and information collected by the nuns and secular nurses about the patient’s conduct since arrival.10 In 1923, institutional capacity had already been exceeded: there were 3,019 committed patients. They were in the care and responsibility of 280 nuns (including 72 graduate nurses), 58 secular care-attendants, three chaplains, four psychiatrists and some ten consulting physicians.11 The same year, Saint-Jean-de-Dieu Hospital received the formal recognition—endorsement—of the Catholic Hospital Association of the United States and Canada and, four years later, the hospital was affiliated with the American Psychiatric Association (APA).12 The time of the highest known number of commitments, about 7,500 patients in 1944, was followed by a period of respite during the post-war years. Progress in medicine, in particular the discovery of antibiotics, and the improvement of living conditions worked to decrease admission requests in the aftermath of the war. While Saint-Jean-de-Dieu was recognised as a research centre dedicated to the treatment of mental illnesses, the asylum officially became a hospital in 1950, the lunatic a mental patient and the commitment a hospitalisation, according to the updated Loi sur les asiles d’aliénés (Law on Lunatic Asylums), renamed the Loi des institutions pour malades mentaux (Law on Institutions for the Mentally Ill).13 While the modified law banned the ‘terms that could seem to be humiliating or even disparaging to the patients or their family’, the causes for commitment remained substantially unchanged.14 It should also be stressed that this period corresponds to what is now known as the third psychiatric revolution, thanks to psychopharmacological advances that included the notorious chlorpromazine. Methodologies Much has been written about Saint-Jean-de-Dieu Hospital, particularly in the 1960s, during a period commonly called Quebec’s Quiet Revolution, when the principle of institutionalisation was angrily criticised.15 Until the 1960s, the psychiatric institution served to remove from the social landscape those deemed mentally disturbed and therefore undesirable to society, but it also sought to treat and care for them, so that they could eventually resume their lives. Historical perspective focusing on the patients’ lives received little attention from historians and sociologists in Quebec, whose main concern was to point out defects in the institutions controlled by Catholic congregations, with a barely veiled intent to find fault, in order to promote the new values of a secular society freed from the Church’s authority.16 Over the last 15 years, however, new perspectives on the history of madness have emerged in Quebec.17 This new reading of the institution’s past is the result of a novel Western approach to formulating historical problems that focuses on patient history.18 Our close study of clinical records from the Saint-Jean-de-Dieu psychiatric hospital aims to uncover traces of the patients’ point of view. In short, over recent years, historians of madness have in a manner of speaking reinvented the past. Historians in Quebec, as well as in France, the USA and Great Britain, ‘[w]hen seeking to reveal the mechanisms of power and domination that determine the order of past collective behaviour, are more inclined to study “people in society’s” capacity to negotiate their way in the world, criticise its course and interpret it in a new light.’19 In studying more than 10,000 of 90,000 clinical records from the Saint-Jean-de-Dieu psychiatric hospital archives, we have conducted an in-depth investigation leading to a better understanding of asylum life, while putting psychiatric patients’ experiences at the forefront. To better comprehend the institutional experience of thousands of women and men committed for reasons of mental illness during the first half of the twentieth century, we thus sought to get behind the asylum walls. History, as Antoine Prost so rightly put it, ‘does not tell “the” truth about “reality”, but rather “some truth” about “a reality”’.20 With this in mind, we wish to clearly state the basis of our quest for information concerning people who were marginalised and committed to psychiatric institutions. Alhough their faces and gestures remain unseen, and their laughter, screams and cries unheard, we attempt to glimpse aspects of their behaviour, grasp fragments of their thoughts, and get a sense of their emotions. Historically, accounts concerning psychiatric patients are not necessarily true beyond doubt and, all too often, discourses attributed to patients are actually those of family members, medical or nursing staff. Nevertheless, traces of patients’ words have been uncovered and allow for the reintroduction of these individual existences into historical discourse. These words or, to use Farge’s term, ‘events of history’ taken from the medical records are grains of ‘truth’ with which to understand, analyse and interpret. This standpoint was introduced in the 1960s by her colleague and future co-author Michel Foucault, as he attempted to convince historians that: [t]he document, then, is no longer for history an inert material through which it tries to reconstitute what men have done or said, the event of which only the trace remains; history is now trying to define within the documentary material itself unities, totalities, series, relations.21 All material that has been developed, described, explained or articulated about psychiatric patients, and sometimes in their name, is not rejected herein.22 Rather, by uncovering traces of patients’ words, a more nuanced perspective on the ‘mentally ill’ becomes clear. Furthermore, the following examination focuses on patient experience in a specific context, namely that of commitment. Employing two methods of analysis, microhistory and inductive contextual analysis with data saturation, the primary material examined is comprised of the words of patients and hospital staff as recorded in hospital files. After many years spent reading thousands of files about patients committed to Saint-Jean-de-Dieu, we have developed an exhaustive knowledge of the archive. These complementary analytical methods, integrated in specific cases, are relevant to a history of psychiatry/madness that takes both a top-down and a bottom-up approach into account, as they are dialectically connected. Archival research, initially inductive, allows researchers to make chance discoveries, and becomes more refined and focused as coherent outlines appear. Conceptual categories that emerge from the reading and rereading of records are defined, not in order to provide a comprehensive portrait of the lives of specific individuals, but rather to grasp what these lives represent in light of the larger context, that of commitment to asylums in Quebec during the first half of the twentieth century. According to historian André Cellard, It is this string of connections between the researcher’s focus and the various observations drawn from the documentation that allows him to form plausible explanations and develop a coherent interpretation, and thus proceed to reconstruct some aspect of a given society at such and such a time.23 The analysis of singular cases provides a better understanding of how individual lives were determined by a specific socio-political and cultural context. The historical narrative produced relies on the extremely rare opportunity to juxtapose data from the medical records with the words of the patients themselves or those of their family members. As Foucault wrote, ‘[h]owever banal it may be, however unimportant its consequences may appear to be, however quickly it may be forgotten after its appearance, however little heard or however badly deciphered we may suppose it to be, a statement is always an event that neither the language (langue) nor the meaning can quite exhaust.’24 Marguerite-Marie and Berthe: Use of microhistory Influenced by Edward Palmer Thompson, microhistory offered historians of the 1970s a new approach.25 Carlo Ginzburg and Natalie Zemon Davis in particular utilised a historical method that sets aside the study of masses or classes to focus on individuals. Cases chosen for analysis present anonymous individuals and lead to the portrayal of singular life experiences. Taking this ‘ground-level’ approach to history, to use Jacques Revel’s term histoire au ras du sol, we examine particularly meaningful medical records from Saint-Jean-de-Dieu.26 The stories of Marguerite-Marie and Berthe, two women committed to Saint-Jean-de-Dieu in 1921 and 1946, respectively, are cases in point. Their words, taken from the archives, are particularly important because they paint a portrait of Quebec society at the time. In particular, they shed light on family relationships, the possible or impossible position of women, institutional politics, procedures for ‘epileptics’ or people who ‘attempt suicide’, as well as treatments and daily life within the institution. Marguerite-Marie’s clear-sightedness and boredom and the cry of rage that testifies to Berthe’s limited horizons call out through the retelling of lives shaped by hardship. The family correspondence uncovered and studied alongside Marguerite-Marie’s clinical records offer unique access to her story, allowing for an analysis of an epileptic’s words, and the discovery of her quest for freedom and love throughout the 29 years she spent at Saint-Jean-de-Dieu. The letters carefully preserved in the institution and family archives reveal a darkly ironic and sarcastic portrait of life in the asylum. On the contrary, Marguerite-Marie’s hospital records resemble the thousands of other records found in the archives of the IUSMM. Twenty-nine years pass quickly over the course of roughly 30 pages, including the patient’s story at admission, medical and nursing notes, minutes from doctors’ meetings, descriptions of mental evolution, the Radiology Department’s report, notes from the surgical unit, a J form (request for temporary patient discharge), letters. When she was admitted, Marguerite-Marie made a favourable impression on the psychiatrists. She responded with aptitude and discernment to their questions, as witnessed in the verbatim report from the doctors’ meeting held on 15 October 1921: Question: Age? Answer: 12 years old. Q: When did you arrive? [Comes from Saint-Anicet.] A: Today. Q: Which day? A: October 10th, 1921. Q: [The patient counts backward and forward very well.] Why did you come here? A: To be treated. Q: For what illness? A: I don’t know what kind of illness I have. Q: Do you faint? A: Every month. Q: Aside from that time of the month do you faint? A: No. [The patient has been to school.] Q: Who discovered Canada? A: Jacques Cartier. Q: Who founded Montreal? A: Maisonneuve. Q: At home, were you ever bad? A: Sometimes. Q: Did you hit your little brothers? A: Sometimes. Q: Did you quarrel with your parents? A: They scolded me. Q: Why? A: Because I acted up. Q: Have you had serious illnesses? A: Only that one. Notes recorded in the file by psychiatrists, nuns or nurses are infrequent. Nevertheless, it is clearly stated on 6 October 1926 that the patient had not had a single epileptic seizure during the previous two years, and had displayed no abnormal psychological or emotional behaviour; in short, ‘it does not seem necessary to prolong her commitment’.27 Although Marguerite-Marie was given a trial discharge in 1924, she was returned to Saint-Jean-de-Dieu and remained until her last breath. Subsequent medical notes and observations on the patient’s mental evolution show that, as a young adult, Marguerite-Marie became more and more short-tempered, angry and even violent. Her epileptic seizures occurred more frequently and she was prone to striking the patients around her, whose presence she did not seem to tolerate.28 The notes recorded in the file during the 1940s mainly concern the medical exams she underwent after having contracted pneumonia. At 40 years of age, her epileptic seizures occurred weekly. Despite all of this, Marguerite-Marie read, worked and kept herself busy. On 15 August 1950, at age 41, she died of pulmonary tuberculosis. The clinical files offer a rather dull portrait of Marguerite-Marie. Her letters to her family, however, reveal a talented, mischievous, romantic and demanding young woman: As you promised to come before long, I’m waiting for you every day. Blandine came two weeks ago, and promised to return with Mother and she hasn’t been able to—maybe she has personal reasons. Mother found herself alone here this time. Yolande hasn’t come since All Saint’s Day—if she isn’t on holiday and she has a servant, I don’t see what’s preventing her, unless she is going to surprise me by arriving at 6 o’clock in the evening, like Blandine did the last time. In any case, Mariette will probably come during the holidays, I am waiting for her with hope.29 Her letters show that family ties were maintained during Marguerite-Marie’s commitment, while penetrating the mysteries surrounding her pastimes, preferences, desires and dreams. Her activities included playing card-games like bridge or 500. She also enjoyed crossword puzzles and liked to read and write. She took an interest in stenography and enjoyed sending riddles in her letters to her sister Cécile, using stenographic signs in order to write as fast as she spoke. During her long commitment, she certainly had the time to put down on paper, meticulously and with style, the often-funny stories that reminded her sister she would not be bored during her next visit to the hospital. Marguerite-Marie’s story demonstrates her strong family ties, the frustration resulting from her commitment, and the fact that she could not return home despite being neither dangerous nor scandalous.30 Marguerite-Marie was committed to Saint-Jean-de-Dieu for epilepsy. Her letters are disturbing insofar as they show no signs of madness but rather a sharp wit. And yet, Marguerite-Marie’s case could fit the definition provided in the 1909 Law on Lunatic Asylums, which governed the commitment process until 1950. The law stated: ‘May be admitted to lunatic asylums, at the government’s expense. … Idiots or imbeciles, when they are dangerous, a source of scandal, subject to epileptic seizures, or monstrous deformity …’31 Marguerite-Marie was one of the 8 per cent of people admitted to Saint-Jean-de-Dieu in 1921 for epileptic madness (Table 1).32 Table 1. Diagnoses at Saint-Jean-de-Dieu in 1920 according to gender Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Note: Patients present on 31 December 1920. Source: Documents from the Province of Quebec’s Parliamentary Session, 1921. Table 1. Diagnoses at Saint-Jean-de-Dieu in 1920 according to gender Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Note: Patients present on 31 December 1920. Source: Documents from the Province of Quebec’s Parliamentary Session, 1921. Marguerite-Marie forged her character behind asylum walls and developed defences to survive her marginalisation. Over a period of almost 30 years, extracts of Marguerite-Marie’s letters, alongside observations recorded in her clinical files, show her to be increasingly short-tempered. Who would not have been? Berthe’s story reveals a very different life from that of Marguerite-Marie, although they shared the asylum experience. In May 1946, at 30 years of age, Berthe was institutionalised after having attempted to take her own life eight times within a two-month period. Berthe’s suicidal behaviour clearly fit the criteria of the 1909 Law on Lunatic Asylums with respect to the danger she posed to her own self. Her diagnosis was ‘Behavioural disorder—Maladjustment’, which is surprising, because it was rare to see a ‘behavioural disorder’ associated with a suicide attempt. A closer study of her record revealed a letter written by her father that sheds light on Berthe’s ambitions and on the frustrations she experienced. An extract of his letter states: Near the end of July 1945, after a night filled with nightmares and hallucinations, following her call, I bring her back to the house; she admits to me that everything is over—the marriage (she hadn’t yet spoken of her relationship, but we were very much suspecting it). During the month of May of last year, after having passed her exams, McGill tries nonetheless to prevent her from continuing her studies, on the pretext that the classes are full of returning soldiers. She persists, tries everything she can, going all the way to the Dean of the university, who intervenes regarding her acceptance, but who, at the same time, warns her that she is doomed to failure if she does not ‘settle the matter’ with her boyfriend. He advises her either to ‘leave him’, ‘live with him’, ‘marry him’, whatever, but to find a definitive solution to her problem. Not long afterwards, she finds out that X has approached the authorities to prevent her from continuing her studies, which hurts her badly.33 Berthe’s medical records contain ‘A Report on Miss Berthe’s Mental State’, which paints the portrait of a young woman whose ambitions were rather different from those of the majority of young women of her day. Berthe was a student of French-Canadian origin, born into a Catholic family, who had always wanted to be a doctor and learned to speak English fluently, in order to study at McGill University.34 She was accepted into the Faculty of Medicine in 1944. Her father reports that Berthe claimed to have lost her faith at the age of 14, although he could not say for what reason. She stopped all religious practice in 1936. In January 1945, she met a man, Walter, whom she described as the love of her life, and who wanted her to abandon her studies. In May 1945, McGill University expelled her on the pretext of welcoming soldiers who were back from the front; in January 1946, she was readmitted. In late February, she slit her wrists for the first time, and went on to attempt suicide seven more times. Berthe ran away from her home, was arrested and imprisoned by police, before being transferred to Saint-Jean-de-Dieu on 25 April. In his notes to the attending physician, her father wrote, ‘We seem to gather from her words that marriage could wash away the stain, and bring her peace if not happiness.’ These two unique cases allow us to better understand individual lives in a specific socio-political and cultural context in Quebec between 1920 and 1950. Marguerite-Marie’s writings tell us of her long years in an institution, the hope that sustained her and her many disappointments. Berthe, who was deemed maladjusted, shows an uncommon strength of character. How many French-Canadian women born in 1915 declared themselves atheists, undertook to study medicine, and rose to the challenge of studying in an English setting? Berthe chose a different path than the traditional one taken by most French-Canadian women from a working-class background, who became mothers of large families and had little formal education.35 The archival material illustrates the connection between Berthe’s diagnosis and the unconventional life choices made by a Quebecoise woman in the 1930s and 1940s. Microhistory provides the time and space necessary to exploring all avenues suggested by a psychiatric record. Natalie Zemon Davis believes it is essential to lend a voice to those who live on the margins of society, in an attempt to ‘recentre’ them and disrupt the norm.36 Her goal is not to decentre the archives, to bring them to her, but rather to decentre herself as a researcher to reach the archives. Davis strongly recommends not following the dominant theoretical trends, in order to always remain on the critical edge. Cases studied through data saturation using inductive contextual analysis The ‘grounded theory’ approach developed by Glaser and Strauss (1967), following the Chicago School’s rules of qualitative analysis, emphasises ‘the importance of the social actors’ perspectives in the definition of their social world, without however neglecting the micro- and macro-social context in which they act’.37 This inductive approach influenced our contextual analysis method, used to study patient records from Saint-Jean-de-Dieu Hospital (more than 90,000 records). On the one hand, contextual analysis emphasises the importance of the social actors’ perspectives in defining their social world. On the other hand, it is not used to describe a specific phenomenon or verify an a priori research hypothesis, but rather to discover and define a subject through the process of reading all available sources. This absence of a predefined research framework is akin to Ginzburg’s concept of estrangement, which consists of an attempt—with an emphasis on the word ‘attempt’—to approach sources with the eyes of a stranger who has no preconceived ideas about, for example, commitment to an asylum.38 Thus, archival research allows researchers to make chance discoveries and becomes more refined and focused as coherent outlines are established. Reading the files generates and defines conceptual categories, not in order to illustrate the lives of specific individuals, but rather to grasp what they represent in light of the larger context, that of commitment to a psychiatric institution. Using the records summary, the patient’s personal and family history, as well as notes from the doctors’ meetings, we are able to identify specific experiences. This method is, however, used to develop relevant theory based on a study of the sources, rather than presenting an exhaustive description of all available cases. To illustrate the contextual analysis, randomly chosen excerpts from sample interviews conducted at the time of admission are presented here. The first concerns a 1931 case of a patient diagnosed with a manic-depressive psychosis and the second a 1946 case of a patient diagnosed with paranoia. Patients committed to Saint-Jean-de-Dieu frequently received one or the other diagnosis based on visible symptoms. Persecutory delusions, hallucinations and conspiracy theories were among the most frequent reasons provided for requesting a patient’s admission. Justifications offered for these requests more often than not betrayed the fear and shame engendered by the irrational behaviour of a family member. In the first example, Adrianna, 36 years of age, was diagnosed with manic depressive psychosis in 1931.39 Q: Have you heard bizarre things? A: I heard things said by men, I don’t want to repeat them, it’s forbidden. Q: Who forbids it? A: God himself. Q: Does God speak to you? A: Yes. Q: What does he say? A: … Q: Has the Devil also spoken to you? A: Yes. Q: What did he say? A: … … Q: Why does God speak to you; do you have a mission? A: Yes, I have a mission to accomplish. Q: What is it? A: The reign of Jesus Christ on earth, by fighting indecent and immoral fashion with a scapular, and low necklines with a medal. … [Here, the patient stops to request that these facts be carefully taken down.] In the second case, Alfred, 54 years of age, is diagnosed with paranoia in 1946.40 [Identifies himself] Q: Occupation? A: I drove a taxi. Q: Why were you arrested? A: Because I didn’t have a license for Montreal. Q: What’s this thing about the triangle? [Does not respond] Q: What happened? A: I didn’t see it myself. Nobody said anything to me about it. It’s what I figure, I don’t have any proof. At one point, it seemed to me that they were there. Q: What does the triangle mean? A: I figure it’s something that’s against me. Q: To attack you, is that it? A: I don’t know. Q: Did you suspect someone? A: No Q: You said that this triangle was against you? A: Yes, but I don’t know, I don’t have any proof. Q: Did you suspect your wife? A: I didn’t think it—I may have said that. She was forced to act. That’s what I suspected. Q: Were there other men who met your wife? A: That’s what I suspected. Q: You lived with your wife? A: Yes. She is president of the Milk Drops, often goes off in the doctor’s car I don’t make a big deal out of it, I don’t suspect her. Q: Was she directly or indirectly involved in the plots? A: All kinds of things. Q: Did you stop working? A: Yes, I bought a taxi in January, I paid $2,000. At the beginning it worked first class, it was coming in by the pocketfuls. Then, the motor stopped working; always at the mechanic’s, I spent $550. I always did something. Everything is going wrong … it’s as if there was a force, behind it all. The language is ambiguous. It is difficult to describe. However, the knowledge obtained in these interviews by the psychiatrists, with respect to the families’ reasons for requesting the patients’ admission, is fairly easy to guess at: hearing God or the Devil, believing oneself to be magnetised, smelling odours or having a theory about the triangle.41 Furthermore, these interviews indicate that the psychiatrists already knew why the patients were admitted, and their questions were tendentious. But they also show that the patients ‘refused’ to say more. They knew where they were—in an insane asylum. They were suspicious of the questions, and sought to protect themselves, or at least not to explicitly express their delusions. Historians’ analysis must account for what was left unsaid. Here, Zemon Davis’s work is of use. About the silences of history, she writes: As I said before, I’m trying to turn these silences into a plus, a silence that signifies, that says something about the place of the man in the society around him and about his personal practices. To speak of what is possible here, I must use my imagination—but it must be nourished by and tightly guided by the sources from and around …42 Between the lines of what was said, refusals and silences are discernible—a man’s jealousy; a woman’s modesty and reserve. Psychiatrists and family members were not indifferent to these issues, and we may presume that they adhered for the most part to the behaviours and ideas expressed, that is, the fear of women’s freedom in the post-war years or of sexual behaviour deemed too liberal and indecent. However, through religious zealotry or excessive control of a wife’s movements, the patients crossed the line. And it is this ambiguous and shifting line that is of interest. The behaviours considered insane occurred within a specific context, that of Quebec in the 1930s and 1940s, which was predominantly rural, poor and Catholic. These records provide material with which to consider the line drawn between madness and ‘normality’ at a specific moment in time. In order to locate similarities and differences, these cases must be examined in relation to other similar cases, of which there are quite a few. Unfortunately, these particular records contain no letters. The patients’ few words upon admission to the hospital, or during subsequent evaluations, are the only clues left illustrating their own point of view. Particular attention must, therefore, be paid to these words, which shape the historical narrative, not as simple, described fact, but as events that are part of a very real social dynamic. As Arlette Farge writes, ‘there is a shift in focus, which gives to these words a status of truth, instead of treating them like simple anecdotes to enliven the historical narrative as a whole.’43 Theoretical Stances on Psychiatric Archives Whether studying one or several cases, the hours spent reading patient records allow us to probe and confirm certain ideas about ‘madness’, but also to let the unexpected arise. The absence of a rigid research framework allows the researcher to remain open to discovery and shapes a theoretical perspective on the very broad subject of ‘madness’, creating a history based on words taken directly from the archives. This perspective relies on sequential and inductive approaches, reaching toward the archives to discover them, listening and displaying the approach itself as ‘proof’, thus following an intuition that, over time, becomes an interpretation. On the subject of data interpretation and in reference to Epictetus, Koselleck writes, ‘It is not deeds that shock humanity, but the words describing them.’44 Seeking to deconstruct stereotypes about madness that emphasise the presumed incoherence or irrationality of patients, or the figure of the wrongfully committed individual, is an important act. There are also long-standing stereotypes about the asylums, which are considered by some scholars to be totalitarian.45 Reading the history of psychiatric institutions with this standard thinking in mind obscures the existential possibilities of individuals living behind asylum walls. Writing psychiatric history while taking the words of asylum inmates into account also means giving power back to the inmates, with respect to what they say or conceal, and what they choose to do or not to do.46 Regarding the eminently Foucauldian concern with the issue of power, the theorist states: It is not true that there are only a few who think, and others who do not. Thought functions much like power. It is not true that in a society certain people have all the power, and below them other people have no power at all. Power should be analysed in terms of complex and shifting strategic relationships, where not everyone occupies the same position, or always remains in that position. The same holds true with regard to thought. There is not, on the one hand, for example, medical knowledge that is to be studied in terms of the history of thought, and, underneath, the behaviour of the sick, which would be material for historical ethnology.47 The existence of power relationships is undeniable. However, it is appropriate to realise that they are not one-dimensional but, rather, ‘dynamic’. Some records do reveal the difficulties of living in the asylum. Yet there are others that shed light, often indirectly, on the complexity of a patient’s personal and family relationships, and thus inspire us to question how the patient uses the institution. Cases of voluntary requests for commitment are an example of this. Some patients wanted to be committed because they felt safer behind asylum walls.48 Such sentiments are reminiscent of those expressed by William Styron, regarding his own commitment, in Darkness Visible.49 The records reveal that madness is rarely ‘absolute’, as well as exposing the patients’ shrewdness. It is also worth noting that each individual has a horizon of possibility which is sometimes open and wide (socially advantaged) and sometimes limited and narrow (socially disadvantaged). These horizons, more often than not limited, must be taken into account. When an individual comes into contact with ‘formal authorities’, such as the medical system, archival traces are found. According to Mario Colucci, ‘absolutely nothing can be known of this individual outside of his contact with power. Power is not only that which annihilates the subjects—as anti-psychiatrists and sociologists would have it—it is literally that which produces them.’50 A discourse about people whose behaviour is deemed inadequate within a certain social order, at a specific place and time, emerges and does not take into account the voices of patients that can still be heard today.51 According to Foucault, ‘the return [of these patients] to reality occurs in the very form in which they were driven out of the world.’52 Detecting the variables that shape individual existence at any given time and place, determining why certain individuals were subjected to medical intervention and isolated from society, while others were not, is a task that merits full attention. Nevertheless, as Foucault believed, the emergence of inglorious, unlucky, unimportant and ordinary people from the past, through their contact with institutions intended to maintain social order and peace, may be a kind of revenge. As Foucault articulated, drunkards, beaten or promiscuous women, unruly adolescents, jealous husbands, delusional monks—these are individuals whose existence allows for reflection about those who do emerge from the shadows, while others, who made just as much noise, remain lost in the silences of history.53 The mad are made into a historical phenomenon by reactions to their behaviours, which cross an ambiguous line in relation to what is considered normal, and are transgressive in a disconcertingly visible way (many people transgress social norms, but remain hidden in order to do so). A tendency to psychopathologise acts seen as irrational, which may include commitment to an institution rather than criminalisation, is also part of this political history. Conclusion In conclusion, our theoretical and methodological questions about these psychiatric clinical records have brought us to reconsider the potential of inductive contextual analysis and microhistory. Historians speculate on what is plausible and possible, explicitly or implicitly, while evaluating their primary sources. Our ‘own’ sources, the medical records of Saint-Jean-de-Dieu, preserve traces which allow us to grasp the patients’ words. To use Farge’s expression, working those words [travailler la parole] enables us to produce both a narrative and a historical interpretation. Without emphasising the power relationships that nobody seeks to deny, the psychiatrist, the nurse or the researcher often have the last word. However, by highlighting the dialogical relationship, our approach to the archives leads rather to a collaborative analysis, as opposed to the more monological approach. This relationship allows us to reach a balance between the words spoken by the patient and those put down on paper by the researcher. In using such methodological approaches, we do not mean to lend socially preconceived or accepted ideas to actors from the past, nor do we intend to highlight ideas in order to emphasise a single point of view. In so doing, no light would be shed on the lives of institutionalised patients, which are glimpsed through the fragments of their words found in the various elements comprising the medical records. It would be impossible to grasp the full complexity of a patient’s personal and family relationships, to question how the institution is used, or speculate on the social actors who either pass through or remain within asylum walls. Writing history from below involves giving power back to the patients, giving them back their agency.54 With the exception of a few historians who write historical narratives based especially on patients’ words, researchers often dismiss these words.55 And yet, while the researcher is present in the selection and editing of material, as well as the narrative framework, they remain invisible in the writing. When the time comes to write a history from below about people institutionalised for madness, we would like to make suppositions, take risks, write maybes or ifs; in short, we would also like to experiment, as Daniel Milo suggests with his experimental or gay history.56 Such a stance opens up possibilities for analysis from a particular perspective, that of researchers who live and think in their own time. Which theoretical (and political) stance may researchers adopt to create a space in which to interpret their sources? In Zemon Davis’s words, ‘a painful or dangerous or vital reality of the present can be examined in light of the past, even though forms and conditions change so much over time: the past offers us ways to reflect on the present with greater nuance, sensitivity and detachment’.57 If the openly subjective position of these bottom-up historical analyses may be displeasing to some, it is the price of a historical perspective that releases the voices of institutionalised patients too often silenced, such as those of the patients committed to Saint-Jean-de-Dieu during the first half of the twentieth century. Footnotes 1 Letter from the patient Marie-Louise to Dr Legrand, 22 August 1931, Institut universitaire en santé mentale de Montréal Archives (henceforth IUSMMA), Record 13353. Transcribed excerpts have not been edited, and sic has not been inserted next to terms or meanings that may appear odd. The aim is to avoid weighing down the text, while making the archive more accessible to readers. 2 For Quebec, see André Cellard, Histoire de la folie et la société au Québec de 1600 à 1850 (Montreal: Boréal, 1991). For Anglophone Canada and the USA, see Cheryl Krasnick-Warsh, Moments of Unreason. The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923 (Montreal and Kingston: McGill-Queen’s University Press, 1989), and Nancy Tomes, A Generous Confidence. Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883 (Cambridge: Cambridge University Press, 1984). 3 André Cellard and Dominique Nadon, ‘Ordre et désordre: le Montreal Lunatic Asylum et la naissance de l’asile au Québec’, Revue d’histoire de l’Amérique française, 1986, 39, 345–67. 4 Cellard, Histoire de la folie, 205. 5 Alcée Tétreault, Cours des maladies mentales donnés à l’Hôpital Saint-Jean-de-Dieu, unpublished manuscrit, Special Collections, University of Montreal, circa 1920. He reproduces the laws governing asylums in the Province of Quebec. 6 Saint-Jean-de-Dieu Hospital became Louis-H.-Lafontaine Hospital in 1976, in an attempt to break with the institution’s dark past and, mainly, to eliminate all traces of religion. In 2012, it received its current name. 7 Bernard Courteau, De Saint-Jean-de-Dieu à Louis H.-Lafontaine, Évolution historique de l’hôpital psychiatrique à Montréal (Montreal: Méridien, 1989), 72. 8 With the politics of early commitment, prevention happened within the asylum walls. Under this system, the asylum population increased significantly and the underfunding of such institutions in Quebec created a problem of economic management. See André M. Paradis, ‘Le sous-financement gouvernemental et son impact sur le développement des asiles francophones au Québec (1845–1918)’, RHAF, 1997, 50, 571–98. After the 1920s, the mental hygiene movement, led by Dr Desloges in Quebec and Dr Clarke in Ontario, tried to prevent insanity outside the asylum walls. See David MacLennan, ‘Beyond the Asylum: Professionalization and the Mental Hygiene Movement in Canada, 1914–1928’, CBMH/BCHM, 1987, 4, 7–23; Robert Bastien and Isabelle Perreault, ‘Propagande d’hygiène mentale au Québec dans les années 1930’, Lien social et Politiques, 2012, 67, 85–105. 9 Tétreault, Cours des maladies, 5. 10 Ibid., 6. 11 Notes historiques de l’Hôpital Saint-Jean-de-Dieu, Montreal, self-publication, 1923, 12. At the beginning of the 1920s, the ‘permanent’ psychiatrists were Drs Devlin, Noël, Tétreault and de Bellefeuille. After 1928, the number of consulting neuropsychiatrists increased considerably. 12 Formerly the American Medico-Psychological Association (AMPA). 13 S.R.Q. 1950, ch.188, Articles 8 and 12, ‘Loi des institutions pour malades mentaux’. 14 Internal documents from the archives of Louis-H. Lafontaine Hospital. 15 Vrai (newspaper), May 1956, A2. The Quiet Revolution in Quebec is a period of rapid changes under the Liberal government of Jean Lesage. See Yvan Lamonde, L’heure de vérité. La laïcité Québécoise à l’épreuve de l’histoire. (Montréal: Del Busso, 2010); Paul-André Linteau, René Durocher, Jean-Claude Robert and François Ricard, Histoire du Québec contemporain. Le Québec depuis 1930 (Montréal: Boréal, 1986), 393–720; François Ricard, La Génération lyrique. Essai sur la vie et l’œuvre des premiers-nés du baby-boom (Montréal: Boréal, 1999). 16 See, for example, Françoise Boudreau, De l’asile à la santé mentale: les soins psychiatriques: Histoire et institutions (Montreal: Saint-Martin, 2002); Denis Goulet and Robert Gagnon, Histoire de la médecine au Québec, 1800–2000: de l’art de soigner à la science de guérir (Québec: Septentrion, 2014). 17 André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Isabelle Perreault, ‘Psychiatrie et ordre social. Analyse des causes d’internement et des diagnostics donnés à Saint-Jean-de-Dieu dans une perspective de genre, 1920–1950’ (doctoral dissertation in History, Université d’Ottawa, 2009); Michèle Nevert, Textes de l’internement. Manuscrits asilaires de Saint-Jean-de-Dieu, vol. 1 (Montreal: XYZ Éditeur, 2010); Mary G. Okin, ‘“Madwomen” in Quebec: An Analysis of the Recurring Themes in the Reasons for Women’s Committal to Beauport, 1894–1940’ (doctoral dissertation, University of Maine, 2008). 18 Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 1985, 14, 175–98. 19 C. Granger, ‘Ouverture. Science et insouciance de l’histoire’, in C. Granger, ed., À quoi pensent les historiens? Faire de l’histoire au xxie siècle (Paris: Éditions Autrement, 2013), 17. For patient historiography, see Kerry Davis, ‘“Silent and Censured Travellers?” Patients’ Narratives and Patients’ Voices: Perspectives on the History of Mental Illness since 1948’, Social History of Medicine, 2001, 14, 267–92; Flurin Condrau, ‘The Patient’s View meets the Clinical Gaze’, Social History of Medicine, 2007, 20, 524–40; Susannah Wilson, Voices from the Asylum: Four French Women Writers, 1850–1920 (Oxford: Oxford University Press, 2010); Brenda A. LeFrançois, Robert Menzies and Geoffrey Reaume, eds, Mad Matters: A Critical Reader in Canadian Mad Studies (Toronto: Canadian Scholars’ Press, 2013); Hazel Morrison, ‘Conversing with the Psychiatrist: Patient Narratives within Glasgow’s Royal Asylum, 1921–1929’, Journal of Literature and Science, 2013, 6, 18–37; Benoît Majerus, Parmi les fous: une histoire sociale de la psychiatrie au XXe siècle (Rennes: Presses Universitaires de Rennes, 2013); Hervé Guillemain, ‘Le soin en psychiatrie dans la France des années 1930. Une observation à partir des dossiers de patients et des manuels de formation infirmières’, Histoire, médecine et santé, 2015, 7, 77–90; S. Chaney, ‘No “sane” Person Would Have Any Idea’: Patients’ Involvement in late Nineteenth-Century British Asylum Psychiatry’, Medical History, 2016, 60, 37–53; Benoît Majerus, ‘Making Sense of the “Chemical Revolution”. Patients’ Voices on the Introduction of Neuroleptics in the 1950s’, Medical History, 2016, 60, 54–66; P. E. Prestwich, ‘Reflections on asylum archives and the experience of mental illness in Paris’, Journal of CHA, 2012, 23, 324–43. 20 Antoine Prost, Douze Leçons sur l’histoire (Paris: Seuil, 1996); quoted from Jean-Claude Ruano-Borbalan, ed., L’histoire aujourd’hui (Paris: Éditions sciences humaines, 1999), 8. Our translation. 21 Michel Foucault, The Archaeology of Knowledge, A. M. Sheridan Smith (trans) (London and New York: Routledge, 2002), 7. 22 Ibid., 35. 23 André Cellard, ‘L’analyse documentaire’, in Jean Poupart et al., La recherche qualitative: enjeux épistémologiques et méthodologiques (Montreal: Gaëtan Morin Éditeur, 1997), 260. Our translation. 24 Foucault, The Archaeology of Knowledge, 31. 25 Edward Palmer Thompson, ‘History from Below’, Times Literary Supplement (7 April 1966), 279–80. 26 Jacques Revel, ‘L’histoire au ras du sol’ (preface), in Giovanni Levi, Pouvoir au village. Histoire d’un exorciste dans le Piémont du XVIIe siècle, Monique Aymard (trans) (Paris: Gallimard, 1985), I–XXXIII. 27 IUSMMA Record 15526, note on patient’s mental evolution, 6 October 1926. 28 IUSMMA, Record 15526, note on patient’s mental evolution, 11 March 1937. 29 Letter from Marguerite-Marie to her sister Cécile, 7 May 1944, IUSMMA, Record 15526. Our translation. 30 Excerpt from the 1909 letter from the medical superintendent to Marguerite-Marie’s mother, unpublished manuscript, Special collections, University of Montreal, sent 15 October 1925. The law is being referred to in the superintendent’s letter, IUSMMA, Record 15526. 31 S.R.Q. [Statuts refondus du Québec/Revised Statutes of Quebec] 1909, vol. II, ch. 4, article 4105, ‘Lunatic Asylums’. Our translation. 32 This data are based on the total number of women admitted to Saint-Jean-de-Dieu in 1921 with a diagnosis of epileptic madness (according to hospital records). 33 IUSMMA, Record 38409. Our translation. 34 IUSMMA, Record 38409. 35 Denyse Baillargeon, Ménagères au temps de la crise (Montreal: Éditions du remue-ménage, 1991). 36 Uneasy Boundaries and Shifting Borders in Gender and Women's Studies. Notes from a talk given by Natalie Zemon Davis at McGill University, 14 February 2013. 37 Barney G. Glaser and Anselm L. Strauss, The Discovery of Grounded Theory: Strategies for Qualitative Research (Chicago: Aldine Publishing Company, 1967). For the quote at the end of the sentence, see Anne Laperrière, ‘La théorisation ancrée [grounded theory]: démarche analytique et comparaison avec des approches apparentées’, in Poupart et al., La recherche qualitative, 309–40, at 312. Our translation. 38 See Carlo Ginzburg, ‘L’historien et l’avocat du diable’, an interview with Charles Illouz and Laurent Vidal (Part 1), Belin/Genèses, 2003–04, 53, 128–9. 39 IUSMMA, Record 22823, doctors’ meeting, 1931. In 1931, Adrianna is diagnosed with puerperal psychosis, then with manic-depressive psychosis, in manic form, and, in 1952, she is diagnosed with chronic paranoid schizophrenia. 40 IUSMMA, Record 38356, meeting held 11 April 1946. Attended by Doctors Richard, Larose, Lapierre and Pilon. Alfred was institutionalised in 1946 and died in 1975. Described before his death as having suffered for years from chronic hallucinatory psychosis, his first symptoms were auditory and sexual hallucinations, as well as persecutory delusions. It is recorded that the ‘patient [is] dangerous to others. … He believes that his wife and children made to carry [sic] groups that persecuted him, and he constantly threatened them.’ 41 For example, we found many cases of patients committed for paranoia related to the Second World War during the early 1940s at Saint-Jean-de-Dieu. 42 Natalie Zemon Davis, A Passion for History: Conversations with Denis Crouzet, Natalie Zemon Davis and Michael Wolfe (trans) (Kirksville, MO: Truman State University Press, 2010), 173–4. 43 Farge, Effusion et tourment, 89. Our translation. 44 Reinhard Koselleck, Futures Past: On the Semantics of Historical Time, Keith Tribe (trans) (New York: Columbia University Press, 2004), 75. 45 Note the questionable French translation of Goffman’s concept of ‘Total Institution’ or ‘institution totalitaire’ [totalitarian institution]. See Erving Goffman, Asiles. Étude sur la condition sociale des malades mentaux, Liliane and Claude Lainé (trans) (Paris: Éditions de Minuit, 1968). The Total Institution, according to Goffman, refers to a place that is self-sufficient, where there is no backstage, and where all is revealed. See Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: Anchor Books, 1961). 46 See, for example, André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Kerry Davis, ‘“Silent and Censured Travellers?” Patients’ Narratives and Patients’ Voices: Perspectives on the History of Mental Illness since 1948’, Social History of Medicine, 2001, 14, 267–92; Benoît Majerus, ‘Making Sense of the “Chemical Revolution”. 47 Michel Foucault, ‘Le style de l’histoire’ (interview with Arlette Farge and Le Matin journalists F. Dumont and J. P. Iommi-Amunategui, Le Matin, 21 February 1984, 2168, 20–1), in Dits et écrits II (Paris: Gallimard, 2001), 1473. Our translation. 48 IUSMMA, Record 18898 (1926) and Record 33784 (1941). 49 William Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990). 50 Mario Colucci, ‘Hystériques, internés, hommes infâmes: Michel Foucault et la résistance au pouvoir’, in Alain Beaulieu, ed., Michel Foucault et le contrôle social, 2005, 66–7. Our translation. 51 Alexandra Bacopoulos-Viau and Aude Fauvel, ‘The Patient’s Turn: Roy Porter and Psychiatry’s Tales, Thirty Years On’, Medical History, 2016, 60, 1–18. 52 Michel Foucault, ‘Lives of Infamous Men’, in James D. Faubion, ed., Power: Essential Works of Michel Foucault, III, Robert Hurley (trans) (New York: New Press, 2000), 164. 53 Ibid., 164–5. 54 Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 1985, 14, 175–98. 55 See, for example, Canadian historians Geoffrey Reaume, Remembrance of Patients Past, Patient Life at the Toronto Hospital for the Insane, 1870–1940 (Don Mills: Oxford University Press, 2000); André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Brenda A. LeFrançois, Robert Menzies and Geoffrey Reaume, Mad Matters. A Critical Reader in Canadian Mad Studies (Toronto: Canadian Scholars’ Press, 2013). 56 Daniel S. Milo, ‘Pour une histoire expérimentale, ou la gaie histoire’, Annales. Économie, Sociétés, Civilisations, 1990, 45, 717–34. 57 Davis, A Passion for History, 12. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

Behind Asylum Walls: Studying the Dialectic Between Psychiatrists and Patients at Montreal’s Saint-Jean-de-Dieu Hospital during the first half of the Twentieth Century

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Oxford University Press
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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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0951-631X
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Abstract

Summary Hospital archives contain traces of psychiatric patients’ words—written and spoken accounts that could be construed as delusional, irrational and poetic. How are these singular historical narratives, transcripts and letters, which are often out of the ordinary, to be addressed? The historian is tempted to write these psychiatric cases off as nothing more than colourful examples. However, as per French historian Arlette Farge, ‘to take this discourse and work with it offers an answer to the desire to reintroduce lives and individualities into the historical narrative’. This paper questions the ways histories of madness are read and written, based on the rare words of patients found in psychiatric archives. How do we analyse these unique traces of intercourse between experts and marginalised individuals? What do they reveal about power relationships or resistance? Which standpoint should be taken, in order to write history from below, given the challenges posed by the narratives and social positions of the actors involved? psychiatric institution, patient records, qualitative methodology, Quebec, twentieth century Dear friend [Dr Legrand] if one day my thougts my ideas my desires come true that woud make the heigt of my hapiness fulfiled dear friend away from you I cry and miss you and if the place lets us I Marie Louise will keep my love for you forever. At present the 25 pils you have prescribed for me have worked well and if you woud like to prescribe a box of them please I wil be able to continue for a wile taking 3 a day.1 The sometimes delirious, irrational and poetic statements and writings of psychiatric patients raise the question: How can a historical narrative based on these singular discourses, transcripts and letters, which often relate unusual events, be produced? The statements and written words of patients are difficult to analyse, as they are extremely rare and mainly recorded by others. Further, an analysis of word fragments found in clinical records must maintain distance from conventional perceptions of madness and psychiatry. Yet, with regards to these singular and possible lives, a researcher’s stance can be critical of psychiatric power, while also acknowledging the agency of institutionalised patients. The following exploration of the dialectic between psychiatrists and patients is based on fragments of sentences and conversations taken from medical records kept at Montreal’s Saint-Jean-de-Dieu Hospital during the twentieth century. A close reading of these records suggests that the patients’ writings clearly challenge the dominant theoretical predispositions of social history, including feminism, Marxism and social control. Far from remaining passive and dominated subjects, patients admitted to a psychiatric institution often make light of professional roles—doctor, psychiatrist, nurse—and, more particularly, of social norms. In this article, we will answer the following questions: How much of the emerging narrative results from the actor’s (patient’s) intended self-revelation, and how much stems from the researcher’s aim to tell the story? How can we negotiate this ambiguous and productive area of historical discourse using today’s theoretical and conceptual tools? Moreover, how are we to analyse these unique traces of intercourse between an expert and a marginalised, institutionalised individual? What do they tell us about power relationships and resistance? How do we write history while taking institutionalised persons into account, despite the challenges posed by the very discourse and social status of the actors concerned? In the following pages, we explore research avenues that illustrate the dynamics between learned actors (psychiatrists) and actors considered insane (patients) in three stages. We begin with a short introduction to the Saint-Jean-de-Dieu Hospital. Secondly, with the help of excerpts from the hospital’s medical records, we outline two possible methods of analysis used in our research. Finally, we discuss theoretical aspects of analysing traces written by oneself to others, and by others about oneself. Saint-Jean-de-Dieu Hospital, 1873–1950 The nineteenth century is known for the construction of vast, veritable asylums.2 In Lower Canada, the first asylum, the Montreal Lunatic Asylum, opened its doors in 1839, as part of the Pied-du-Courant prison in Montreal.3 Lunatics, melancholics, fools and the mad were committed for short periods of time up until 1845. When the Montreal Lunatic Asylum closed, the patients were transferred to the Beauport Asylum in the Quebec City area, the first permanent asylum in Canada. Beauport was organised along the lines of the Glasgow asylum in Scotland.4 It was thus set within a context of large-scale immigration from Britain, especially Ireland, of growing urbanisation and socio-ethnic conflict, of the economic crisis of the 1830s, and an upsurge of misery and destitution, that politicians and social experts started trying to manage deviant behaviours. In effect, the mad were increasingly perceived as people who put other members of society in danger, as much a result of their scandalousness as of their harmfulness. During the second half of the nineteenth century in Canada, two large asylums were built in the Montreal region: Saint-Jean-de-Dieu for the Catholics and the Protestant Hospital for the Insane for the Protestants and the Jews.5 The institution of interest here, Saint-Jean-de-Dieu, is located on the eastern part of the island of Montreal, and opened its doors in 1873 (Figure 1). Known today as the Institut Universitaire en Santé Mentale de Montréal (IUSMM),6 Saint-Jean-de-Dieu Hospital was, with its twelve large pavilions, host to 1844 patients in 1901.7 As such, an attempt was made to prevent chronic and incurable madness by establishing a system of early commitment, rather than simply relieving society of its mad people. The pool of behaviours associated with insanity was consequently broadened and the asylum population increased.8 Fig. 1 View largeDownload slide Photograph of Saint-Jean-de-Dieu Hospital in 1934 Source: Documents de la session parlementaire de la Province de Québec, 1935, 68, IV, 106. Fig. 1 View largeDownload slide Photograph of Saint-Jean-de-Dieu Hospital in 1934 Source: Documents de la session parlementaire de la Province de Québec, 1935, 68, IV, 106. While the majority of patients were committed for reasons of familial and social security, therapeutic approaches were being developed, and the 1920s saw changes in the methods of treating patients. For example, the hydrotherapy system was set up in 1921 and, the following year, a department with specialised personnel was devoted to occupational therapy. Around the same time, ‘doctors’ meetings’ were organised. These weekly meetings allowed the psychiatrists to collaborate, in order to better determine the diagnoses for new admissions. Patient examinations took place in three stages. First, notes were taken on the patient’s attitude, the way they walked, their clothes, smell, manners (if relevant) and their facial expressions.9 Next came an interrogation, based on about 20 questions, which allowed the doctors to evaluate the degree of orientation in time and space and sensory capacity of the patient. Based on the patient’s responses, the doctors determined their affectivity, memory, judgement and reactions, and whether they were suffering from delusions, hallucinations or conspiracy theories. Finally, the meeting concluded with an analysis of the information provided by the people who had requested the commitment and information collected by the nuns and secular nurses about the patient’s conduct since arrival.10 In 1923, institutional capacity had already been exceeded: there were 3,019 committed patients. They were in the care and responsibility of 280 nuns (including 72 graduate nurses), 58 secular care-attendants, three chaplains, four psychiatrists and some ten consulting physicians.11 The same year, Saint-Jean-de-Dieu Hospital received the formal recognition—endorsement—of the Catholic Hospital Association of the United States and Canada and, four years later, the hospital was affiliated with the American Psychiatric Association (APA).12 The time of the highest known number of commitments, about 7,500 patients in 1944, was followed by a period of respite during the post-war years. Progress in medicine, in particular the discovery of antibiotics, and the improvement of living conditions worked to decrease admission requests in the aftermath of the war. While Saint-Jean-de-Dieu was recognised as a research centre dedicated to the treatment of mental illnesses, the asylum officially became a hospital in 1950, the lunatic a mental patient and the commitment a hospitalisation, according to the updated Loi sur les asiles d’aliénés (Law on Lunatic Asylums), renamed the Loi des institutions pour malades mentaux (Law on Institutions for the Mentally Ill).13 While the modified law banned the ‘terms that could seem to be humiliating or even disparaging to the patients or their family’, the causes for commitment remained substantially unchanged.14 It should also be stressed that this period corresponds to what is now known as the third psychiatric revolution, thanks to psychopharmacological advances that included the notorious chlorpromazine. Methodologies Much has been written about Saint-Jean-de-Dieu Hospital, particularly in the 1960s, during a period commonly called Quebec’s Quiet Revolution, when the principle of institutionalisation was angrily criticised.15 Until the 1960s, the psychiatric institution served to remove from the social landscape those deemed mentally disturbed and therefore undesirable to society, but it also sought to treat and care for them, so that they could eventually resume their lives. Historical perspective focusing on the patients’ lives received little attention from historians and sociologists in Quebec, whose main concern was to point out defects in the institutions controlled by Catholic congregations, with a barely veiled intent to find fault, in order to promote the new values of a secular society freed from the Church’s authority.16 Over the last 15 years, however, new perspectives on the history of madness have emerged in Quebec.17 This new reading of the institution’s past is the result of a novel Western approach to formulating historical problems that focuses on patient history.18 Our close study of clinical records from the Saint-Jean-de-Dieu psychiatric hospital aims to uncover traces of the patients’ point of view. In short, over recent years, historians of madness have in a manner of speaking reinvented the past. Historians in Quebec, as well as in France, the USA and Great Britain, ‘[w]hen seeking to reveal the mechanisms of power and domination that determine the order of past collective behaviour, are more inclined to study “people in society’s” capacity to negotiate their way in the world, criticise its course and interpret it in a new light.’19 In studying more than 10,000 of 90,000 clinical records from the Saint-Jean-de-Dieu psychiatric hospital archives, we have conducted an in-depth investigation leading to a better understanding of asylum life, while putting psychiatric patients’ experiences at the forefront. To better comprehend the institutional experience of thousands of women and men committed for reasons of mental illness during the first half of the twentieth century, we thus sought to get behind the asylum walls. History, as Antoine Prost so rightly put it, ‘does not tell “the” truth about “reality”, but rather “some truth” about “a reality”’.20 With this in mind, we wish to clearly state the basis of our quest for information concerning people who were marginalised and committed to psychiatric institutions. Alhough their faces and gestures remain unseen, and their laughter, screams and cries unheard, we attempt to glimpse aspects of their behaviour, grasp fragments of their thoughts, and get a sense of their emotions. Historically, accounts concerning psychiatric patients are not necessarily true beyond doubt and, all too often, discourses attributed to patients are actually those of family members, medical or nursing staff. Nevertheless, traces of patients’ words have been uncovered and allow for the reintroduction of these individual existences into historical discourse. These words or, to use Farge’s term, ‘events of history’ taken from the medical records are grains of ‘truth’ with which to understand, analyse and interpret. This standpoint was introduced in the 1960s by her colleague and future co-author Michel Foucault, as he attempted to convince historians that: [t]he document, then, is no longer for history an inert material through which it tries to reconstitute what men have done or said, the event of which only the trace remains; history is now trying to define within the documentary material itself unities, totalities, series, relations.21 All material that has been developed, described, explained or articulated about psychiatric patients, and sometimes in their name, is not rejected herein.22 Rather, by uncovering traces of patients’ words, a more nuanced perspective on the ‘mentally ill’ becomes clear. Furthermore, the following examination focuses on patient experience in a specific context, namely that of commitment. Employing two methods of analysis, microhistory and inductive contextual analysis with data saturation, the primary material examined is comprised of the words of patients and hospital staff as recorded in hospital files. After many years spent reading thousands of files about patients committed to Saint-Jean-de-Dieu, we have developed an exhaustive knowledge of the archive. These complementary analytical methods, integrated in specific cases, are relevant to a history of psychiatry/madness that takes both a top-down and a bottom-up approach into account, as they are dialectically connected. Archival research, initially inductive, allows researchers to make chance discoveries, and becomes more refined and focused as coherent outlines appear. Conceptual categories that emerge from the reading and rereading of records are defined, not in order to provide a comprehensive portrait of the lives of specific individuals, but rather to grasp what these lives represent in light of the larger context, that of commitment to asylums in Quebec during the first half of the twentieth century. According to historian André Cellard, It is this string of connections between the researcher’s focus and the various observations drawn from the documentation that allows him to form plausible explanations and develop a coherent interpretation, and thus proceed to reconstruct some aspect of a given society at such and such a time.23 The analysis of singular cases provides a better understanding of how individual lives were determined by a specific socio-political and cultural context. The historical narrative produced relies on the extremely rare opportunity to juxtapose data from the medical records with the words of the patients themselves or those of their family members. As Foucault wrote, ‘[h]owever banal it may be, however unimportant its consequences may appear to be, however quickly it may be forgotten after its appearance, however little heard or however badly deciphered we may suppose it to be, a statement is always an event that neither the language (langue) nor the meaning can quite exhaust.’24 Marguerite-Marie and Berthe: Use of microhistory Influenced by Edward Palmer Thompson, microhistory offered historians of the 1970s a new approach.25 Carlo Ginzburg and Natalie Zemon Davis in particular utilised a historical method that sets aside the study of masses or classes to focus on individuals. Cases chosen for analysis present anonymous individuals and lead to the portrayal of singular life experiences. Taking this ‘ground-level’ approach to history, to use Jacques Revel’s term histoire au ras du sol, we examine particularly meaningful medical records from Saint-Jean-de-Dieu.26 The stories of Marguerite-Marie and Berthe, two women committed to Saint-Jean-de-Dieu in 1921 and 1946, respectively, are cases in point. Their words, taken from the archives, are particularly important because they paint a portrait of Quebec society at the time. In particular, they shed light on family relationships, the possible or impossible position of women, institutional politics, procedures for ‘epileptics’ or people who ‘attempt suicide’, as well as treatments and daily life within the institution. Marguerite-Marie’s clear-sightedness and boredom and the cry of rage that testifies to Berthe’s limited horizons call out through the retelling of lives shaped by hardship. The family correspondence uncovered and studied alongside Marguerite-Marie’s clinical records offer unique access to her story, allowing for an analysis of an epileptic’s words, and the discovery of her quest for freedom and love throughout the 29 years she spent at Saint-Jean-de-Dieu. The letters carefully preserved in the institution and family archives reveal a darkly ironic and sarcastic portrait of life in the asylum. On the contrary, Marguerite-Marie’s hospital records resemble the thousands of other records found in the archives of the IUSMM. Twenty-nine years pass quickly over the course of roughly 30 pages, including the patient’s story at admission, medical and nursing notes, minutes from doctors’ meetings, descriptions of mental evolution, the Radiology Department’s report, notes from the surgical unit, a J form (request for temporary patient discharge), letters. When she was admitted, Marguerite-Marie made a favourable impression on the psychiatrists. She responded with aptitude and discernment to their questions, as witnessed in the verbatim report from the doctors’ meeting held on 15 October 1921: Question: Age? Answer: 12 years old. Q: When did you arrive? [Comes from Saint-Anicet.] A: Today. Q: Which day? A: October 10th, 1921. Q: [The patient counts backward and forward very well.] Why did you come here? A: To be treated. Q: For what illness? A: I don’t know what kind of illness I have. Q: Do you faint? A: Every month. Q: Aside from that time of the month do you faint? A: No. [The patient has been to school.] Q: Who discovered Canada? A: Jacques Cartier. Q: Who founded Montreal? A: Maisonneuve. Q: At home, were you ever bad? A: Sometimes. Q: Did you hit your little brothers? A: Sometimes. Q: Did you quarrel with your parents? A: They scolded me. Q: Why? A: Because I acted up. Q: Have you had serious illnesses? A: Only that one. Notes recorded in the file by psychiatrists, nuns or nurses are infrequent. Nevertheless, it is clearly stated on 6 October 1926 that the patient had not had a single epileptic seizure during the previous two years, and had displayed no abnormal psychological or emotional behaviour; in short, ‘it does not seem necessary to prolong her commitment’.27 Although Marguerite-Marie was given a trial discharge in 1924, she was returned to Saint-Jean-de-Dieu and remained until her last breath. Subsequent medical notes and observations on the patient’s mental evolution show that, as a young adult, Marguerite-Marie became more and more short-tempered, angry and even violent. Her epileptic seizures occurred more frequently and she was prone to striking the patients around her, whose presence she did not seem to tolerate.28 The notes recorded in the file during the 1940s mainly concern the medical exams she underwent after having contracted pneumonia. At 40 years of age, her epileptic seizures occurred weekly. Despite all of this, Marguerite-Marie read, worked and kept herself busy. On 15 August 1950, at age 41, she died of pulmonary tuberculosis. The clinical files offer a rather dull portrait of Marguerite-Marie. Her letters to her family, however, reveal a talented, mischievous, romantic and demanding young woman: As you promised to come before long, I’m waiting for you every day. Blandine came two weeks ago, and promised to return with Mother and she hasn’t been able to—maybe she has personal reasons. Mother found herself alone here this time. Yolande hasn’t come since All Saint’s Day—if she isn’t on holiday and she has a servant, I don’t see what’s preventing her, unless she is going to surprise me by arriving at 6 o’clock in the evening, like Blandine did the last time. In any case, Mariette will probably come during the holidays, I am waiting for her with hope.29 Her letters show that family ties were maintained during Marguerite-Marie’s commitment, while penetrating the mysteries surrounding her pastimes, preferences, desires and dreams. Her activities included playing card-games like bridge or 500. She also enjoyed crossword puzzles and liked to read and write. She took an interest in stenography and enjoyed sending riddles in her letters to her sister Cécile, using stenographic signs in order to write as fast as she spoke. During her long commitment, she certainly had the time to put down on paper, meticulously and with style, the often-funny stories that reminded her sister she would not be bored during her next visit to the hospital. Marguerite-Marie’s story demonstrates her strong family ties, the frustration resulting from her commitment, and the fact that she could not return home despite being neither dangerous nor scandalous.30 Marguerite-Marie was committed to Saint-Jean-de-Dieu for epilepsy. Her letters are disturbing insofar as they show no signs of madness but rather a sharp wit. And yet, Marguerite-Marie’s case could fit the definition provided in the 1909 Law on Lunatic Asylums, which governed the commitment process until 1950. The law stated: ‘May be admitted to lunatic asylums, at the government’s expense. … Idiots or imbeciles, when they are dangerous, a source of scandal, subject to epileptic seizures, or monstrous deformity …’31 Marguerite-Marie was one of the 8 per cent of people admitted to Saint-Jean-de-Dieu in 1921 for epileptic madness (Table 1).32 Table 1. Diagnoses at Saint-Jean-de-Dieu in 1920 according to gender Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Note: Patients present on 31 December 1920. Source: Documents from the Province of Quebec’s Parliamentary Session, 1921. Table 1. Diagnoses at Saint-Jean-de-Dieu in 1920 according to gender Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Type of mental illness  Men  Women  Total  %  Mania  102  128  230  9.0  Melancholia  155  136  291  11.0  Periodic madness  6  2  8  0.3  Systematic madness  291  309  600  23.0  Mental confusion  47  50  97  4.0  Dementia praecox  32  34  66  3.0  Vesanic dementia  67  75  142  5.0  Organic dementia  19  8  27  1.0  Senile dementia  41  40  81  3.0  General paralysis  25  10  35  1.0  Neurotic madness—epilepsy  111  94  205  8.0  Neurotic madness—other neuroses  4  7  11  0.4  Toxic madness—alcohol  65  11  76  3.0  Toxic madness—other substances  6  2  8  0.3  Cerebral syphilis  4  0  4  0.2  Retardation—with/without epilepsy  434  283  717  28.0  Under observation  4  1  5  0.2  Total  1413  1190  2603  100.0  Note: Patients present on 31 December 1920. Source: Documents from the Province of Quebec’s Parliamentary Session, 1921. Marguerite-Marie forged her character behind asylum walls and developed defences to survive her marginalisation. Over a period of almost 30 years, extracts of Marguerite-Marie’s letters, alongside observations recorded in her clinical files, show her to be increasingly short-tempered. Who would not have been? Berthe’s story reveals a very different life from that of Marguerite-Marie, although they shared the asylum experience. In May 1946, at 30 years of age, Berthe was institutionalised after having attempted to take her own life eight times within a two-month period. Berthe’s suicidal behaviour clearly fit the criteria of the 1909 Law on Lunatic Asylums with respect to the danger she posed to her own self. Her diagnosis was ‘Behavioural disorder—Maladjustment’, which is surprising, because it was rare to see a ‘behavioural disorder’ associated with a suicide attempt. A closer study of her record revealed a letter written by her father that sheds light on Berthe’s ambitions and on the frustrations she experienced. An extract of his letter states: Near the end of July 1945, after a night filled with nightmares and hallucinations, following her call, I bring her back to the house; she admits to me that everything is over—the marriage (she hadn’t yet spoken of her relationship, but we were very much suspecting it). During the month of May of last year, after having passed her exams, McGill tries nonetheless to prevent her from continuing her studies, on the pretext that the classes are full of returning soldiers. She persists, tries everything she can, going all the way to the Dean of the university, who intervenes regarding her acceptance, but who, at the same time, warns her that she is doomed to failure if she does not ‘settle the matter’ with her boyfriend. He advises her either to ‘leave him’, ‘live with him’, ‘marry him’, whatever, but to find a definitive solution to her problem. Not long afterwards, she finds out that X has approached the authorities to prevent her from continuing her studies, which hurts her badly.33 Berthe’s medical records contain ‘A Report on Miss Berthe’s Mental State’, which paints the portrait of a young woman whose ambitions were rather different from those of the majority of young women of her day. Berthe was a student of French-Canadian origin, born into a Catholic family, who had always wanted to be a doctor and learned to speak English fluently, in order to study at McGill University.34 She was accepted into the Faculty of Medicine in 1944. Her father reports that Berthe claimed to have lost her faith at the age of 14, although he could not say for what reason. She stopped all religious practice in 1936. In January 1945, she met a man, Walter, whom she described as the love of her life, and who wanted her to abandon her studies. In May 1945, McGill University expelled her on the pretext of welcoming soldiers who were back from the front; in January 1946, she was readmitted. In late February, she slit her wrists for the first time, and went on to attempt suicide seven more times. Berthe ran away from her home, was arrested and imprisoned by police, before being transferred to Saint-Jean-de-Dieu on 25 April. In his notes to the attending physician, her father wrote, ‘We seem to gather from her words that marriage could wash away the stain, and bring her peace if not happiness.’ These two unique cases allow us to better understand individual lives in a specific socio-political and cultural context in Quebec between 1920 and 1950. Marguerite-Marie’s writings tell us of her long years in an institution, the hope that sustained her and her many disappointments. Berthe, who was deemed maladjusted, shows an uncommon strength of character. How many French-Canadian women born in 1915 declared themselves atheists, undertook to study medicine, and rose to the challenge of studying in an English setting? Berthe chose a different path than the traditional one taken by most French-Canadian women from a working-class background, who became mothers of large families and had little formal education.35 The archival material illustrates the connection between Berthe’s diagnosis and the unconventional life choices made by a Quebecoise woman in the 1930s and 1940s. Microhistory provides the time and space necessary to exploring all avenues suggested by a psychiatric record. Natalie Zemon Davis believes it is essential to lend a voice to those who live on the margins of society, in an attempt to ‘recentre’ them and disrupt the norm.36 Her goal is not to decentre the archives, to bring them to her, but rather to decentre herself as a researcher to reach the archives. Davis strongly recommends not following the dominant theoretical trends, in order to always remain on the critical edge. Cases studied through data saturation using inductive contextual analysis The ‘grounded theory’ approach developed by Glaser and Strauss (1967), following the Chicago School’s rules of qualitative analysis, emphasises ‘the importance of the social actors’ perspectives in the definition of their social world, without however neglecting the micro- and macro-social context in which they act’.37 This inductive approach influenced our contextual analysis method, used to study patient records from Saint-Jean-de-Dieu Hospital (more than 90,000 records). On the one hand, contextual analysis emphasises the importance of the social actors’ perspectives in defining their social world. On the other hand, it is not used to describe a specific phenomenon or verify an a priori research hypothesis, but rather to discover and define a subject through the process of reading all available sources. This absence of a predefined research framework is akin to Ginzburg’s concept of estrangement, which consists of an attempt—with an emphasis on the word ‘attempt’—to approach sources with the eyes of a stranger who has no preconceived ideas about, for example, commitment to an asylum.38 Thus, archival research allows researchers to make chance discoveries and becomes more refined and focused as coherent outlines are established. Reading the files generates and defines conceptual categories, not in order to illustrate the lives of specific individuals, but rather to grasp what they represent in light of the larger context, that of commitment to a psychiatric institution. Using the records summary, the patient’s personal and family history, as well as notes from the doctors’ meetings, we are able to identify specific experiences. This method is, however, used to develop relevant theory based on a study of the sources, rather than presenting an exhaustive description of all available cases. To illustrate the contextual analysis, randomly chosen excerpts from sample interviews conducted at the time of admission are presented here. The first concerns a 1931 case of a patient diagnosed with a manic-depressive psychosis and the second a 1946 case of a patient diagnosed with paranoia. Patients committed to Saint-Jean-de-Dieu frequently received one or the other diagnosis based on visible symptoms. Persecutory delusions, hallucinations and conspiracy theories were among the most frequent reasons provided for requesting a patient’s admission. Justifications offered for these requests more often than not betrayed the fear and shame engendered by the irrational behaviour of a family member. In the first example, Adrianna, 36 years of age, was diagnosed with manic depressive psychosis in 1931.39 Q: Have you heard bizarre things? A: I heard things said by men, I don’t want to repeat them, it’s forbidden. Q: Who forbids it? A: God himself. Q: Does God speak to you? A: Yes. Q: What does he say? A: … Q: Has the Devil also spoken to you? A: Yes. Q: What did he say? A: … … Q: Why does God speak to you; do you have a mission? A: Yes, I have a mission to accomplish. Q: What is it? A: The reign of Jesus Christ on earth, by fighting indecent and immoral fashion with a scapular, and low necklines with a medal. … [Here, the patient stops to request that these facts be carefully taken down.] In the second case, Alfred, 54 years of age, is diagnosed with paranoia in 1946.40 [Identifies himself] Q: Occupation? A: I drove a taxi. Q: Why were you arrested? A: Because I didn’t have a license for Montreal. Q: What’s this thing about the triangle? [Does not respond] Q: What happened? A: I didn’t see it myself. Nobody said anything to me about it. It’s what I figure, I don’t have any proof. At one point, it seemed to me that they were there. Q: What does the triangle mean? A: I figure it’s something that’s against me. Q: To attack you, is that it? A: I don’t know. Q: Did you suspect someone? A: No Q: You said that this triangle was against you? A: Yes, but I don’t know, I don’t have any proof. Q: Did you suspect your wife? A: I didn’t think it—I may have said that. She was forced to act. That’s what I suspected. Q: Were there other men who met your wife? A: That’s what I suspected. Q: You lived with your wife? A: Yes. She is president of the Milk Drops, often goes off in the doctor’s car I don’t make a big deal out of it, I don’t suspect her. Q: Was she directly or indirectly involved in the plots? A: All kinds of things. Q: Did you stop working? A: Yes, I bought a taxi in January, I paid $2,000. At the beginning it worked first class, it was coming in by the pocketfuls. Then, the motor stopped working; always at the mechanic’s, I spent $550. I always did something. Everything is going wrong … it’s as if there was a force, behind it all. The language is ambiguous. It is difficult to describe. However, the knowledge obtained in these interviews by the psychiatrists, with respect to the families’ reasons for requesting the patients’ admission, is fairly easy to guess at: hearing God or the Devil, believing oneself to be magnetised, smelling odours or having a theory about the triangle.41 Furthermore, these interviews indicate that the psychiatrists already knew why the patients were admitted, and their questions were tendentious. But they also show that the patients ‘refused’ to say more. They knew where they were—in an insane asylum. They were suspicious of the questions, and sought to protect themselves, or at least not to explicitly express their delusions. Historians’ analysis must account for what was left unsaid. Here, Zemon Davis’s work is of use. About the silences of history, she writes: As I said before, I’m trying to turn these silences into a plus, a silence that signifies, that says something about the place of the man in the society around him and about his personal practices. To speak of what is possible here, I must use my imagination—but it must be nourished by and tightly guided by the sources from and around …42 Between the lines of what was said, refusals and silences are discernible—a man’s jealousy; a woman’s modesty and reserve. Psychiatrists and family members were not indifferent to these issues, and we may presume that they adhered for the most part to the behaviours and ideas expressed, that is, the fear of women’s freedom in the post-war years or of sexual behaviour deemed too liberal and indecent. However, through religious zealotry or excessive control of a wife’s movements, the patients crossed the line. And it is this ambiguous and shifting line that is of interest. The behaviours considered insane occurred within a specific context, that of Quebec in the 1930s and 1940s, which was predominantly rural, poor and Catholic. These records provide material with which to consider the line drawn between madness and ‘normality’ at a specific moment in time. In order to locate similarities and differences, these cases must be examined in relation to other similar cases, of which there are quite a few. Unfortunately, these particular records contain no letters. The patients’ few words upon admission to the hospital, or during subsequent evaluations, are the only clues left illustrating their own point of view. Particular attention must, therefore, be paid to these words, which shape the historical narrative, not as simple, described fact, but as events that are part of a very real social dynamic. As Arlette Farge writes, ‘there is a shift in focus, which gives to these words a status of truth, instead of treating them like simple anecdotes to enliven the historical narrative as a whole.’43 Theoretical Stances on Psychiatric Archives Whether studying one or several cases, the hours spent reading patient records allow us to probe and confirm certain ideas about ‘madness’, but also to let the unexpected arise. The absence of a rigid research framework allows the researcher to remain open to discovery and shapes a theoretical perspective on the very broad subject of ‘madness’, creating a history based on words taken directly from the archives. This perspective relies on sequential and inductive approaches, reaching toward the archives to discover them, listening and displaying the approach itself as ‘proof’, thus following an intuition that, over time, becomes an interpretation. On the subject of data interpretation and in reference to Epictetus, Koselleck writes, ‘It is not deeds that shock humanity, but the words describing them.’44 Seeking to deconstruct stereotypes about madness that emphasise the presumed incoherence or irrationality of patients, or the figure of the wrongfully committed individual, is an important act. There are also long-standing stereotypes about the asylums, which are considered by some scholars to be totalitarian.45 Reading the history of psychiatric institutions with this standard thinking in mind obscures the existential possibilities of individuals living behind asylum walls. Writing psychiatric history while taking the words of asylum inmates into account also means giving power back to the inmates, with respect to what they say or conceal, and what they choose to do or not to do.46 Regarding the eminently Foucauldian concern with the issue of power, the theorist states: It is not true that there are only a few who think, and others who do not. Thought functions much like power. It is not true that in a society certain people have all the power, and below them other people have no power at all. Power should be analysed in terms of complex and shifting strategic relationships, where not everyone occupies the same position, or always remains in that position. The same holds true with regard to thought. There is not, on the one hand, for example, medical knowledge that is to be studied in terms of the history of thought, and, underneath, the behaviour of the sick, which would be material for historical ethnology.47 The existence of power relationships is undeniable. However, it is appropriate to realise that they are not one-dimensional but, rather, ‘dynamic’. Some records do reveal the difficulties of living in the asylum. Yet there are others that shed light, often indirectly, on the complexity of a patient’s personal and family relationships, and thus inspire us to question how the patient uses the institution. Cases of voluntary requests for commitment are an example of this. Some patients wanted to be committed because they felt safer behind asylum walls.48 Such sentiments are reminiscent of those expressed by William Styron, regarding his own commitment, in Darkness Visible.49 The records reveal that madness is rarely ‘absolute’, as well as exposing the patients’ shrewdness. It is also worth noting that each individual has a horizon of possibility which is sometimes open and wide (socially advantaged) and sometimes limited and narrow (socially disadvantaged). These horizons, more often than not limited, must be taken into account. When an individual comes into contact with ‘formal authorities’, such as the medical system, archival traces are found. According to Mario Colucci, ‘absolutely nothing can be known of this individual outside of his contact with power. Power is not only that which annihilates the subjects—as anti-psychiatrists and sociologists would have it—it is literally that which produces them.’50 A discourse about people whose behaviour is deemed inadequate within a certain social order, at a specific place and time, emerges and does not take into account the voices of patients that can still be heard today.51 According to Foucault, ‘the return [of these patients] to reality occurs in the very form in which they were driven out of the world.’52 Detecting the variables that shape individual existence at any given time and place, determining why certain individuals were subjected to medical intervention and isolated from society, while others were not, is a task that merits full attention. Nevertheless, as Foucault believed, the emergence of inglorious, unlucky, unimportant and ordinary people from the past, through their contact with institutions intended to maintain social order and peace, may be a kind of revenge. As Foucault articulated, drunkards, beaten or promiscuous women, unruly adolescents, jealous husbands, delusional monks—these are individuals whose existence allows for reflection about those who do emerge from the shadows, while others, who made just as much noise, remain lost in the silences of history.53 The mad are made into a historical phenomenon by reactions to their behaviours, which cross an ambiguous line in relation to what is considered normal, and are transgressive in a disconcertingly visible way (many people transgress social norms, but remain hidden in order to do so). A tendency to psychopathologise acts seen as irrational, which may include commitment to an institution rather than criminalisation, is also part of this political history. Conclusion In conclusion, our theoretical and methodological questions about these psychiatric clinical records have brought us to reconsider the potential of inductive contextual analysis and microhistory. Historians speculate on what is plausible and possible, explicitly or implicitly, while evaluating their primary sources. Our ‘own’ sources, the medical records of Saint-Jean-de-Dieu, preserve traces which allow us to grasp the patients’ words. To use Farge’s expression, working those words [travailler la parole] enables us to produce both a narrative and a historical interpretation. Without emphasising the power relationships that nobody seeks to deny, the psychiatrist, the nurse or the researcher often have the last word. However, by highlighting the dialogical relationship, our approach to the archives leads rather to a collaborative analysis, as opposed to the more monological approach. This relationship allows us to reach a balance between the words spoken by the patient and those put down on paper by the researcher. In using such methodological approaches, we do not mean to lend socially preconceived or accepted ideas to actors from the past, nor do we intend to highlight ideas in order to emphasise a single point of view. In so doing, no light would be shed on the lives of institutionalised patients, which are glimpsed through the fragments of their words found in the various elements comprising the medical records. It would be impossible to grasp the full complexity of a patient’s personal and family relationships, to question how the institution is used, or speculate on the social actors who either pass through or remain within asylum walls. Writing history from below involves giving power back to the patients, giving them back their agency.54 With the exception of a few historians who write historical narratives based especially on patients’ words, researchers often dismiss these words.55 And yet, while the researcher is present in the selection and editing of material, as well as the narrative framework, they remain invisible in the writing. When the time comes to write a history from below about people institutionalised for madness, we would like to make suppositions, take risks, write maybes or ifs; in short, we would also like to experiment, as Daniel Milo suggests with his experimental or gay history.56 Such a stance opens up possibilities for analysis from a particular perspective, that of researchers who live and think in their own time. Which theoretical (and political) stance may researchers adopt to create a space in which to interpret their sources? In Zemon Davis’s words, ‘a painful or dangerous or vital reality of the present can be examined in light of the past, even though forms and conditions change so much over time: the past offers us ways to reflect on the present with greater nuance, sensitivity and detachment’.57 If the openly subjective position of these bottom-up historical analyses may be displeasing to some, it is the price of a historical perspective that releases the voices of institutionalised patients too often silenced, such as those of the patients committed to Saint-Jean-de-Dieu during the first half of the twentieth century. Footnotes 1 Letter from the patient Marie-Louise to Dr Legrand, 22 August 1931, Institut universitaire en santé mentale de Montréal Archives (henceforth IUSMMA), Record 13353. Transcribed excerpts have not been edited, and sic has not been inserted next to terms or meanings that may appear odd. The aim is to avoid weighing down the text, while making the archive more accessible to readers. 2 For Quebec, see André Cellard, Histoire de la folie et la société au Québec de 1600 à 1850 (Montreal: Boréal, 1991). For Anglophone Canada and the USA, see Cheryl Krasnick-Warsh, Moments of Unreason. The Practice of Canadian Psychiatry and the Homewood Retreat, 1883–1923 (Montreal and Kingston: McGill-Queen’s University Press, 1989), and Nancy Tomes, A Generous Confidence. Thomas Story Kirkbride and the Art of Asylum-Keeping, 1840–1883 (Cambridge: Cambridge University Press, 1984). 3 André Cellard and Dominique Nadon, ‘Ordre et désordre: le Montreal Lunatic Asylum et la naissance de l’asile au Québec’, Revue d’histoire de l’Amérique française, 1986, 39, 345–67. 4 Cellard, Histoire de la folie, 205. 5 Alcée Tétreault, Cours des maladies mentales donnés à l’Hôpital Saint-Jean-de-Dieu, unpublished manuscrit, Special Collections, University of Montreal, circa 1920. He reproduces the laws governing asylums in the Province of Quebec. 6 Saint-Jean-de-Dieu Hospital became Louis-H.-Lafontaine Hospital in 1976, in an attempt to break with the institution’s dark past and, mainly, to eliminate all traces of religion. In 2012, it received its current name. 7 Bernard Courteau, De Saint-Jean-de-Dieu à Louis H.-Lafontaine, Évolution historique de l’hôpital psychiatrique à Montréal (Montreal: Méridien, 1989), 72. 8 With the politics of early commitment, prevention happened within the asylum walls. Under this system, the asylum population increased significantly and the underfunding of such institutions in Quebec created a problem of economic management. See André M. Paradis, ‘Le sous-financement gouvernemental et son impact sur le développement des asiles francophones au Québec (1845–1918)’, RHAF, 1997, 50, 571–98. After the 1920s, the mental hygiene movement, led by Dr Desloges in Quebec and Dr Clarke in Ontario, tried to prevent insanity outside the asylum walls. See David MacLennan, ‘Beyond the Asylum: Professionalization and the Mental Hygiene Movement in Canada, 1914–1928’, CBMH/BCHM, 1987, 4, 7–23; Robert Bastien and Isabelle Perreault, ‘Propagande d’hygiène mentale au Québec dans les années 1930’, Lien social et Politiques, 2012, 67, 85–105. 9 Tétreault, Cours des maladies, 5. 10 Ibid., 6. 11 Notes historiques de l’Hôpital Saint-Jean-de-Dieu, Montreal, self-publication, 1923, 12. At the beginning of the 1920s, the ‘permanent’ psychiatrists were Drs Devlin, Noël, Tétreault and de Bellefeuille. After 1928, the number of consulting neuropsychiatrists increased considerably. 12 Formerly the American Medico-Psychological Association (AMPA). 13 S.R.Q. 1950, ch.188, Articles 8 and 12, ‘Loi des institutions pour malades mentaux’. 14 Internal documents from the archives of Louis-H. Lafontaine Hospital. 15 Vrai (newspaper), May 1956, A2. The Quiet Revolution in Quebec is a period of rapid changes under the Liberal government of Jean Lesage. See Yvan Lamonde, L’heure de vérité. La laïcité Québécoise à l’épreuve de l’histoire. (Montréal: Del Busso, 2010); Paul-André Linteau, René Durocher, Jean-Claude Robert and François Ricard, Histoire du Québec contemporain. Le Québec depuis 1930 (Montréal: Boréal, 1986), 393–720; François Ricard, La Génération lyrique. Essai sur la vie et l’œuvre des premiers-nés du baby-boom (Montréal: Boréal, 1999). 16 See, for example, Françoise Boudreau, De l’asile à la santé mentale: les soins psychiatriques: Histoire et institutions (Montreal: Saint-Martin, 2002); Denis Goulet and Robert Gagnon, Histoire de la médecine au Québec, 1800–2000: de l’art de soigner à la science de guérir (Québec: Septentrion, 2014). 17 André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Isabelle Perreault, ‘Psychiatrie et ordre social. Analyse des causes d’internement et des diagnostics donnés à Saint-Jean-de-Dieu dans une perspective de genre, 1920–1950’ (doctoral dissertation in History, Université d’Ottawa, 2009); Michèle Nevert, Textes de l’internement. Manuscrits asilaires de Saint-Jean-de-Dieu, vol. 1 (Montreal: XYZ Éditeur, 2010); Mary G. Okin, ‘“Madwomen” in Quebec: An Analysis of the Recurring Themes in the Reasons for Women’s Committal to Beauport, 1894–1940’ (doctoral dissertation, University of Maine, 2008). 18 Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 1985, 14, 175–98. 19 C. Granger, ‘Ouverture. Science et insouciance de l’histoire’, in C. Granger, ed., À quoi pensent les historiens? Faire de l’histoire au xxie siècle (Paris: Éditions Autrement, 2013), 17. For patient historiography, see Kerry Davis, ‘“Silent and Censured Travellers?” Patients’ Narratives and Patients’ Voices: Perspectives on the History of Mental Illness since 1948’, Social History of Medicine, 2001, 14, 267–92; Flurin Condrau, ‘The Patient’s View meets the Clinical Gaze’, Social History of Medicine, 2007, 20, 524–40; Susannah Wilson, Voices from the Asylum: Four French Women Writers, 1850–1920 (Oxford: Oxford University Press, 2010); Brenda A. LeFrançois, Robert Menzies and Geoffrey Reaume, eds, Mad Matters: A Critical Reader in Canadian Mad Studies (Toronto: Canadian Scholars’ Press, 2013); Hazel Morrison, ‘Conversing with the Psychiatrist: Patient Narratives within Glasgow’s Royal Asylum, 1921–1929’, Journal of Literature and Science, 2013, 6, 18–37; Benoît Majerus, Parmi les fous: une histoire sociale de la psychiatrie au XXe siècle (Rennes: Presses Universitaires de Rennes, 2013); Hervé Guillemain, ‘Le soin en psychiatrie dans la France des années 1930. Une observation à partir des dossiers de patients et des manuels de formation infirmières’, Histoire, médecine et santé, 2015, 7, 77–90; S. Chaney, ‘No “sane” Person Would Have Any Idea’: Patients’ Involvement in late Nineteenth-Century British Asylum Psychiatry’, Medical History, 2016, 60, 37–53; Benoît Majerus, ‘Making Sense of the “Chemical Revolution”. Patients’ Voices on the Introduction of Neuroleptics in the 1950s’, Medical History, 2016, 60, 54–66; P. E. Prestwich, ‘Reflections on asylum archives and the experience of mental illness in Paris’, Journal of CHA, 2012, 23, 324–43. 20 Antoine Prost, Douze Leçons sur l’histoire (Paris: Seuil, 1996); quoted from Jean-Claude Ruano-Borbalan, ed., L’histoire aujourd’hui (Paris: Éditions sciences humaines, 1999), 8. Our translation. 21 Michel Foucault, The Archaeology of Knowledge, A. M. Sheridan Smith (trans) (London and New York: Routledge, 2002), 7. 22 Ibid., 35. 23 André Cellard, ‘L’analyse documentaire’, in Jean Poupart et al., La recherche qualitative: enjeux épistémologiques et méthodologiques (Montreal: Gaëtan Morin Éditeur, 1997), 260. Our translation. 24 Foucault, The Archaeology of Knowledge, 31. 25 Edward Palmer Thompson, ‘History from Below’, Times Literary Supplement (7 April 1966), 279–80. 26 Jacques Revel, ‘L’histoire au ras du sol’ (preface), in Giovanni Levi, Pouvoir au village. Histoire d’un exorciste dans le Piémont du XVIIe siècle, Monique Aymard (trans) (Paris: Gallimard, 1985), I–XXXIII. 27 IUSMMA Record 15526, note on patient’s mental evolution, 6 October 1926. 28 IUSMMA, Record 15526, note on patient’s mental evolution, 11 March 1937. 29 Letter from Marguerite-Marie to her sister Cécile, 7 May 1944, IUSMMA, Record 15526. Our translation. 30 Excerpt from the 1909 letter from the medical superintendent to Marguerite-Marie’s mother, unpublished manuscript, Special collections, University of Montreal, sent 15 October 1925. The law is being referred to in the superintendent’s letter, IUSMMA, Record 15526. 31 S.R.Q. [Statuts refondus du Québec/Revised Statutes of Quebec] 1909, vol. II, ch. 4, article 4105, ‘Lunatic Asylums’. Our translation. 32 This data are based on the total number of women admitted to Saint-Jean-de-Dieu in 1921 with a diagnosis of epileptic madness (according to hospital records). 33 IUSMMA, Record 38409. Our translation. 34 IUSMMA, Record 38409. 35 Denyse Baillargeon, Ménagères au temps de la crise (Montreal: Éditions du remue-ménage, 1991). 36 Uneasy Boundaries and Shifting Borders in Gender and Women's Studies. Notes from a talk given by Natalie Zemon Davis at McGill University, 14 February 2013. 37 Barney G. Glaser and Anselm L. Strauss, The Discovery of Grounded Theory: Strategies for Qualitative Research (Chicago: Aldine Publishing Company, 1967). For the quote at the end of the sentence, see Anne Laperrière, ‘La théorisation ancrée [grounded theory]: démarche analytique et comparaison avec des approches apparentées’, in Poupart et al., La recherche qualitative, 309–40, at 312. Our translation. 38 See Carlo Ginzburg, ‘L’historien et l’avocat du diable’, an interview with Charles Illouz and Laurent Vidal (Part 1), Belin/Genèses, 2003–04, 53, 128–9. 39 IUSMMA, Record 22823, doctors’ meeting, 1931. In 1931, Adrianna is diagnosed with puerperal psychosis, then with manic-depressive psychosis, in manic form, and, in 1952, she is diagnosed with chronic paranoid schizophrenia. 40 IUSMMA, Record 38356, meeting held 11 April 1946. Attended by Doctors Richard, Larose, Lapierre and Pilon. Alfred was institutionalised in 1946 and died in 1975. Described before his death as having suffered for years from chronic hallucinatory psychosis, his first symptoms were auditory and sexual hallucinations, as well as persecutory delusions. It is recorded that the ‘patient [is] dangerous to others. … He believes that his wife and children made to carry [sic] groups that persecuted him, and he constantly threatened them.’ 41 For example, we found many cases of patients committed for paranoia related to the Second World War during the early 1940s at Saint-Jean-de-Dieu. 42 Natalie Zemon Davis, A Passion for History: Conversations with Denis Crouzet, Natalie Zemon Davis and Michael Wolfe (trans) (Kirksville, MO: Truman State University Press, 2010), 173–4. 43 Farge, Effusion et tourment, 89. Our translation. 44 Reinhard Koselleck, Futures Past: On the Semantics of Historical Time, Keith Tribe (trans) (New York: Columbia University Press, 2004), 75. 45 Note the questionable French translation of Goffman’s concept of ‘Total Institution’ or ‘institution totalitaire’ [totalitarian institution]. See Erving Goffman, Asiles. Étude sur la condition sociale des malades mentaux, Liliane and Claude Lainé (trans) (Paris: Éditions de Minuit, 1968). The Total Institution, according to Goffman, refers to a place that is self-sufficient, where there is no backstage, and where all is revealed. See Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: Anchor Books, 1961). 46 See, for example, André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Kerry Davis, ‘“Silent and Censured Travellers?” Patients’ Narratives and Patients’ Voices: Perspectives on the History of Mental Illness since 1948’, Social History of Medicine, 2001, 14, 267–92; Benoît Majerus, ‘Making Sense of the “Chemical Revolution”. 47 Michel Foucault, ‘Le style de l’histoire’ (interview with Arlette Farge and Le Matin journalists F. Dumont and J. P. Iommi-Amunategui, Le Matin, 21 February 1984, 2168, 20–1), in Dits et écrits II (Paris: Gallimard, 2001), 1473. Our translation. 48 IUSMMA, Record 18898 (1926) and Record 33784 (1941). 49 William Styron, Darkness Visible: A Memoir of Madness (New York: Random House, 1990). 50 Mario Colucci, ‘Hystériques, internés, hommes infâmes: Michel Foucault et la résistance au pouvoir’, in Alain Beaulieu, ed., Michel Foucault et le contrôle social, 2005, 66–7. Our translation. 51 Alexandra Bacopoulos-Viau and Aude Fauvel, ‘The Patient’s Turn: Roy Porter and Psychiatry’s Tales, Thirty Years On’, Medical History, 2016, 60, 1–18. 52 Michel Foucault, ‘Lives of Infamous Men’, in James D. Faubion, ed., Power: Essential Works of Michel Foucault, III, Robert Hurley (trans) (New York: New Press, 2000), 164. 53 Ibid., 164–5. 54 Roy Porter, ‘The Patient’s View: Doing Medical History from Below’, Theory and Society, 1985, 14, 175–98. 55 See, for example, Canadian historians Geoffrey Reaume, Remembrance of Patients Past, Patient Life at the Toronto Hospital for the Insane, 1870–1940 (Don Mills: Oxford University Press, 2000); André Cellard and Marie-Claude Thifault, Une toupie sur la tête. Visages de la folie à Saint-Jean-de-Dieu (Montreal: Boréal, 2007); Brenda A. LeFrançois, Robert Menzies and Geoffrey Reaume, Mad Matters. A Critical Reader in Canadian Mad Studies (Toronto: Canadian Scholars’ Press, 2013). 56 Daniel S. Milo, ‘Pour une histoire expérimentale, ou la gaie histoire’, Annales. Économie, Sociétés, Civilisations, 1990, 45, 717–34. 57 Davis, A Passion for History, 12. © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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Social History of MedicineOxford University Press

Published: Dec 8, 2017

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