"Foisted upon the government": institutions and the impact of public policy upon the aged. The elderly patients of Rockwood Asylum, 1866-1906.

There is a great deal of controversy concerning the amount of care families have been willing to provide for the dependent aged in the past. A wide variety of historical writings about public institutions have highlighted the fact that the number of aged people admitted to Houses of Industry or Refuge and Insane asylums increased dramatically during the later decades of the nineteenth century. This information has often been used to argue that families demonstrated a widespread lack of concern for the well-being of the aged. Historians, such as Brian Gratton and Carole Haber, however, contend that this was not the case. Instead they assert the families provided a great deal of care for their aged kin and that this level of care remained constant throughout the latter part of the last century.

The family care debate is particularly evident in the literature on nineteenth-century insane asylums. On one side, historians such as Andrew Scull argue that the increase in aged admissions to asylums during the latter decades of the nineteenth-century was due to the fact that, as asylums became more common, the stigma attached to consigning burdensome relatives to asylums evaporated along with any sense of remorse over abandoning familial and kinship obligations. He contends that asylums tended to decrease the tolerance families had for difficult relatives, and as a result, families became increasingly willing to institutionalize their aged kin. According to Scull, therefore, asylums became a "convenient place to get rid of inconvenient people."(1) Similarly, Richard Fox has claimed that families committed the aged to asylums because it was an easy way to rid themselves of the burden of accommodating persons who had become bothersome and who were unable to contribute their share to the family production.(2)

Meanwhile, Gerald Grob and John Walton assert that rather than institutionalizing the aged because they could not be bothered to care for them, families usually committed their elderly relatives to asylums because they lacked the resources necessary to maintain them and they had no other options.(3) As well, Walton confirms that rather than being merely inconvenient people who were sent to asylums, it was usually only the violent, disruptive and difficult to handle who were institutionalized.(4)

This paper is an attempt to determine if families in nineteenth-century Ontario acted as Andrew Scull suggests and abandoned their burdensome aged relatives to insane asylums to be rid of them or if they committed elderly people to institutions only as a last desperate resort in the absence of viable alternatives. An examination of the both the official reports of Medical Superintendent of the Rockwood Asylum for the Insane in Kingston, Ontario, and the case-files of people over the age of sixty admitted to the institution between 1866 and 1906, reveals that there were striking discrepancies between the information located in the patient files and that presented in the reports of the asylum administrators. Asylum administrators, it appears, exaggerated the degree to which families sent aged people to the asylum without just cause. They also ignored the evidence in their own patient files which indicated that many of the families who did commit their aged relatives to the asylum were, for a variety of reasons, completely unable to cope with the financial, physical, or psychological pressures involved in caring for an ill or senile old person. These administrators also failed to note the substantial amounts of care families had provided for their aged kin prior to being forced to send them to Rockwood.

It is easy to understand why historians reading the official reports of asylum administrators would initially conclude that a large number of families were abandoning their aged in institutions. These documents are replete with examples of "helpless old dements", who could be "easily cared for at home," if only their families were not so willing to heartlessly shirk their responsibilities and send their aged relatives to an insane asylum. In the view of most administrators few of the old people sent to asylums were insane; most were merely suffering from the ravages of senility. As the inspector of the Hamilton Asylum reported in 1899, "many (patients) are old people suffering from mental senility; the family may be unable to provide the means of caring for them. They are sent to the asylum simply for safe keeping and to ease the burden upon the friends."(5)

As the number of elderly people in the overall population grew, the admission of senile old people into Rockwood increased. Asylum superintendents feared that mental institutions would fill to capacity with the incurable and the unwanted. As one administrator lamented, the asylum "is no longer a hospital for the insane, but a veritable 'Home for Incurables'."(6) More importantly, officials questioned whether asylum funds could be properly used to maintain chronic cases, as the care of these people was, by 1897, becoming "an enormous tax upon the state."(7) As the Medical Superintendent of the Hamilton Asylum reported, "a great difference of opinion has existed in regard to the best method of caring for the chronic insane, chiefly from an economic standpoint."(8) As far as the admission of senile old people was concerned, it was believed that the:

very liberality of the Government in providing such ample accommodation at cheap rates, or even free, acts as a powerful stimulus in deciding to transfer the burden from the home to the state.(9)

It was asserted that Government was being called upon, with increasing frequency, to assume burdens which, "in all fairness, should be carried by the people."(10)

Being both alarmed and dismayed at what they felt was the unacceptable size of the elderly population within institutions, asylum administrators began to advocate admission policies which insisted that "until homes and refuges for aged people become generally established, the applications to admit victims of senility should be severely discouraged."(11) Officials argued that "cases of purely senile dementia should not be properly numbered among the insane."(12) These people, it was reported, arrived at the institution not because they required care, but "through the importunity of their friends."(13) Family situation, however, played a large role in determining whether an aged person was defined as senile or insane, and therefore eligible for asylum treatment.

It is evident that authorities were more willing to accept a person as insane if he or she had no relatives. When an aged patient had a family, however, that patient would usually be classified as being "merely senile" regardless of the behavior they exhibited, since it was assumed that families should be responsible for their aged kin.(14) Thus, at the very point when aged population was growing and their families experienced an increasing need for the services of the province's insane asylums, the hospitals, in an attempt to reduce costs, were endeavoring to restrict the aged's access to institutions. This policy also accounts for many of the public statements made concerning the degree to which families were heartlessly abandoning their elderly in asylums. It appears that government officials decided they could shame families into accepting a greater share of responsibility for the care of senile old people by asserting that there was a growing tendency among the relatives of the senile to "foist them upon the Government."(15) According to published official documents, therefore, the increase in elderly admissions to insane asylums was due to the growing indifference on the part of families towards their aged kin. A very different image emerges, however, when the actual case-files of the elderly people admitted to the province's hospitals for the insane, such as Kingston's Rockwood Asylum, are examined.

Rockwood Asylum for the Insane was established in Kingston, Ontario, in 1858 as a hospital for the province's criminally insane, but as early as 1862 it was noted that as well as those of the "criminal class" the asylum housed "lunatics of every description".(16) After confederation Rockwood became a Federal concern but it was returned to provincial control in 1872. As private mental hospitals never housed more than a fraction of Ontario's insane during the nineteenth-century, Rockwood, being one of the larger mental institutions, accounted for between 12% and 20% of the province's total insane asylum population in any given year. Of the 4,204 patients admitted to Rockwood between 1866 and 1906, 315, or 7.4% of the total were over the age of sixty.(17)

This total aged population is often lower than the various totals found in the annual reports of the asylum superintendents. This is mainly because the numbers used here do not include people who, while they may have been in the asylum as elderly people, had been admitted to the institution at a much earlier age. Asylum officials would often cite numbers, such as the number of aged people who died in the asylum in any given year, which included all elderly people in the asylum regardless of when they had been admitted, even though it was clear that people who were admitted when they were actually over the age of sixty often formed a minority of these deaths. In this manner, however, officials could provide the public with an inflated impression of the degree to which the aged were over-populating asylums. For instance in 1893 almost all of the elderly people who died in the Toronto Asylum had been admitted to the asylum when they were middle aged or younger. One sixty-eight year old man had been in the institution for forty-five years.(18) While these people may have been in the asylum when over the age of sixty, they were admitted to the asylum before they reached that age. Hence, one cannot justifiably use these people as a source of information concerning the admissions of aged people into institutions.

Aged admissions to Rockwood were not constant. Both the number of aged people in the asylum and the portion of the institution's population they represented changed over time. There were no elderly persons admitted to Rockwood before 1866 and, until 1881, there were rarely more than two or three people over the age of sixty admitted in any given year. In total during the first twenty-three years of operation, thirty-six elderly persons were sent to the asylum. In the next sixteen years, however, 205 aged people were admitted. While the aged never formed more than 3% of the total admissions before 1879, they composed over 12% of the new arrivals in 1895, and almost 14% by 1903. Given that the aged formed 3.1% of the total population of the province in 1851, 7.2% by 1891, and 8.4% by 1901, it appears that over the course of the century the aged came to represent a portion of the insane asylum admissions that was increasingly greater that their demographic presence in the overall population would seemingly justify. [ILLUSTRATION FOR FIGURE I OMITTED]

While it is true that the aged did become a larger presence in mental institutions during the latter years of the nineteenth-century, the actual portion of the total aged population found inside insane asylums changed little between 1866 and 1906. This can be explained by the fact that while the aged portion of the asylum admissions changed dramatically over time, the increase in the actual number of patients involved was small. For instance, while the aged portion of the Rockwood's admissions grew between 1866 and 1906, from 3% to 14% of the total number of people committed, most of the growth taking place after 1890, the resulting increase in the aged population of the asylum was not significant. This group grew from two aged people in 1866 to a maximum of sixty-four between that date and 1901. Thus, the apparently alarming 11% increase in the portion of the asylum's admissions who were aged led to the addition of only sixty-two elderly residents to the asylum population. (see Table I) This pattern was similar throughout the various provincial asylums. At the same time the seemingly small increase in the aged portion of the total provincial population, from 7.2% in 1891 to 8.4% in 1901, masked the fact that the aged population actually increased by 30,000 people.

Nevertheless, the argument that families were abandoning the aged in institutions in ever increasing numbers was promoted by the fact that once admitted to the asylum few aged people left alive. Only one quarter of the aged people admitted to Rockwood were eventually discharged. Most of these discharges, however, occurred around the turn of the century when hospital administrators were hesitant to admit and reluctant to retain chronically ill elderly patients. The bulk of the aged people who arrived at Rockwood remained there until they died (58%) or were transferred to another asylum (18%) where most eventually died. [ILLUSTRATION FOR FIGURE II OMITTED]

Considering that the aged comprised an ever increasing portion of the patients admitted to Rockwood, constituting a greater portion of the total asylum population, and that once inside the institution most aged people remained until they died, it is easy to see why asylum officials argued that many families were refusing to care for their aged members. It is also easy to understand why some historians have supported these officials' arguments, taking the reports of asylum administrators and the various statistics they produced in defense of their statements at face value.

The case-files of the elderly patients at Rockwood, however, contradict most of the statements found in the official reports of the institutions. Instead, these records indicate that few families committed their aged members to the asylum by choice. Most did so out of necessity.(19) These records also suggest that when aged people were refused admission to an asylum as a means of encouraging or forcing their families to care for them, on the assumption that they would be better cared for by kin, both the aged and their families suffered.

Table I

Aged Asylum Population Compared to the Total Population of Rockwood
Asylum

                  Total Asylum        # of Aged        Aged as %
Year               Population         Residents         of Total

1866-67                116                2                1.7%
1875                   362               12                3.3%
1879-80                433               33                7.6%
1884-85                500               50               10.0%
1887                   681               56                8.2%
1890                   674               56                8.3%
1895                   565               54                9.6%
1897                                     64
1899                   558               46                8.2%

Source: AR (1866-1899) and also AO:RG 10: Series 20-F-1 Case-files.

All the people referred to in the following pages were patients or relatives of patients in the Rockwood Asylum. All information about them was obtained from the Asylum's patient case-files. Ontario's Freedom of Information Act prohibits mentioning the full names or case-file numbers of these patients. For this reason individual cases have not been footnoted.

The records reveal that there were some harmless patients who really did not need to be placed in an asylum. A small number were in fact abandoned by relatives who just did not want the responsibility of caring for an elderly person and found the institution to be a convenient place to dump "granny". Nevertheless, a complete lack of family was a more frequent cause of committal than having been abandoned by relatives: people with no immediate family were over-represented among the aged patients in the asylum. This is obvious in cases of never-married people. While less than 10% of the over-all population remained single in nineteenth-century Ontario, over 16% of Rockwood's elderly patients were single.(20) Another 26% of those admitted were widowed. This figure was also higher than the portion of widowed old people in the general population. While roughly half of the old people in Rockwood had a living spouse, married people formed a considerably higher portion (75%) of the general population outside the asylum. Even among the aged, approximately two-thirds of the total population was married.

It also appears that people with no living children formed a greater portion of the population inside the asylum than they did outside its walls. Although one quarter of the case files do not indicate how many children a patient had, over 30% of the patients for whom the number of children was reported had none. In a further 8% of these cases the individual had only one child.

When one notes who provided care for Rockwood's elderly patients before they were admitted to the institution, the reasons people with no spouse and no children were over-represented in the asylum's aged population become apparent. Of the aged people studied, 134 or 43% of them had previously been cared for by a family member. [ILLUSTRATION FOR FIGURE III OMITTED] Almost three quarters of these people were tended by a spouse or a child, mainly wives and daughters. Although siblings, nieces, nephews and even neighbors took care of single or childless people, in most cases the absence of immediate family members meant that an aged person had no-one to look after them when they became incapable of doing so for themselves. The patients of Rockwood bear testimony to the fact that having no relatives greatly increased an old person's chances of being placed in an asylum.

These figures illustrate that rather than being negligent towards their ill and aged relatives, or being eager to abandon them to the "tender care of the community," families, especially spouses and children, played a crucial role in providing care that kept many elderly out of institutions. However, while families may have been willing to assist their kin, this did not mean that they were always able to do so. Providing physical care for an elderly person, especially when mental illness or senility made them difficult to manage, usually was an arduous task. Even people who were willing to look after an aged relative often found that they had conflicting responsibilities to other people, usually their spouses, children or employers.(21)

Sometimes when a person was potentially manageable at home, certain families did not have the resources to cope with the financial burden. More than ethnicity or religion, economic situation determined how long a family could keep an insane relative at home. As one observer commented in 1885, "Rockwood's five hundred and five residents were paupers, with the exception of the very few who pay the cost of their own maintenance."(23) These people could not afford to halt their daily activities, especially work which provided their livelihood, to remain by an elderly person's side. One woman, for example, could not be left at home because as long as she was there her husband could not leave home to go to work and he could not afford to stop working to care for her. Most people did not have the time or the energy to both earn a living and care for an elderly family member. When the asylum officials requested that one woman remove her father from the asylum as he "was well enough to be cared for at home," she lamented that:

I cannot do for my father as I should like to. I work long hours to keep a roof over my head and food to eat. I have no means whatever to pay for an attendant on my father. I dare not stop work to wait upon him, even if I was strong enough to do it.

Some people were simply too ill or feeble themselves to undertake the care of another. For instance, one man explained in a letter that he could not care for his wife as he was poor, ill and in need of medical attention himself. As the care required by an ill older person increased and began to demand more and more of a relative's, or even an entire family's time and energy, these compounded obligations often became more than many individuals or families could handle.(24)

During the latter part of the nineteenth-century this problem became more acute as more people survived to old age, and a greater number of families found themselves faced with the responsibility of caring for aged kin.(25) However, a lack of resources, both financial and human, made it increasingly difficult if not absolutely impossible for some families to shoulder responsibility for the ill.(26)

As Cheryl Warsh explains, demographic changes during the nineteenth century, especially a steady decline in fertility throughout the century led to smaller families.(27) People also experienced greater geographic mobility. As one newspaper commented "keeping up the family attachment" was difficult when business and other pursuits scattered family members to distant residences.(28) The result of these trends was that there were fewer people at home to care for sick or aged relatives.(29) Aside from the well-meaning, but rarely sufficient, help of neighbors and other kin, care-givers often had to shoulder the entire burden of what could amount to around-the-clock care for their ill aged kin. Few of these care-givers had any professional training or medical knowledge, and only rarely did they have sufficient access to people who did.(30) Even if a person required no specialized care, a family member was at the very least obligated to bathe him, cook special foods for him, prepare his medicines, and change and wash his bedclothes. When these extra tasks are combined with the normal tasks involved in caring for a family and running a nineteenth-century household, it is easy to see how the workload could become unbearable, especially when this work was combined with the stress of dealing with a senile person's incontinence, aggression, wandering, violence, or inappropriate sexual behavior.(31) Frequently, when the illness of an elderly person advanced to a stage that required specialized care, the families and individuals who were providing this care simply could not cope.(32)

Once a family had reached the limits of their power to care for someone there were few places they could turn to for help. In Ontario, official attitudes towards assisting families who were caring for the ill and insane hardened noticeably in the latter decades of the century. In 1857, the Superintendent of the Toronto Asylum for the Insane acknowledged that there were in the asylum several senile old people "who with adequate legislative provision for their support may live locally" and might have been "permitted the continuance of the most prized of all human privileges, personal liberty."(33) By the end of the century, in contrast, it was felt that while assistance could be provided to individuals caring for unrelated people, "it would be unwise to pay relatives for the care of their own."(34) Hence, there was little assistance or relief available for families caring for the senile. The result was that with no form of financial or care-giving assistance available for those attempting to cope with the considerable demands(35) placed on people tending kin suffering from the ravages of senile dementia, many families, whatever their wishes in principle, had no choice but to institutionalize an elderly relative or face financial ruin.(36) Others were forced to send their kin away to protect themselves from emotional trauma or actual bodily harm. In this regard nineteenth-century families came to view asylums "as regrettable but indispensable necessities."(37) Many families had no alternatives if the family was to survive.(38) Also, whether they were adequate or not, insane asylums were the only places a confused or ill aged person could receive anywhere near the amount of supervision or medical care they needed.(39)

Rather than recognizing that families usually had genuine reasons for committing their elderly relatives to an asylum, government policy made the process of committal as difficult as possible. Regulations dictated that there were two methods by which a family could have a difficult person admitted into an insane asylum: ordinary process and warrants. Families seeking to admit a relative through ordinary process needed three physicians to certify that the person was insane. Once a person had been certified, he or she would be eligible for admission into a hospital once a bed became available. Given the crowded state of the province's asylums during most of the nineteenth-century, it was almost impossible for a person to gain admission to an asylum in this way; people could wait for months and still see no vacancy appear.(40)

A more expedient process involved warrants. Public authorities such as justices of the peace, magistrates or jail doctors could confine a person in a local jail and then issue a warrant testifying that the person was a "dangerous lunatic", meaning that he or she posed a threat to self or community. Asylums were forced to admit warrant patients regardless of the number of free beds. Hence, many families found themselves forced to have their kin imprisoned and declared insane and dangerous in order to secure them admission to an asylum.(41) As the Medical Superintendent of the Rockwood Asylum declared in 1882, "many patients sought admission through ordinary process, but owing to the crowded state of the asylum and our inability to receive them, promptly many of these applicants were afterwards committed to a jail and transferred to the asylum under warrant."(42) Under such a system it was almost impossible for a family to send a loved one to an asylum in an unfrenzied manner. Hence, aside from the basic stigma attached to being treated for mental illness,(43) the "indignity" of being committed to a nineteenth-century asylum often included being confined in one of the province's "squalid and inhumane" district jails.(44) Almost one third of the elderly people in Rockwood arrived there from a cell in a county jail after having been labelled "dangerous lunatics", many of them so designated merely because that was what was necessary to get them into the asylum.

Considering that a high portion of the aged residents of the asylum had been placed first in jail cells, it is understandable that Rockwood's Chief medical superintendent remarked in 1899 that the fact so many patients "should have had to pass through the goals before reaching this institution is a reproach to the people of the district from which we receive admissions."(45) What the superintendent failed to mention in this indictment of the populace was that once a person became unmanageable at home, a family often had no choice but to send them to a jail, since this was the only way to ensure that the person would eventually be sent to an asylum where they could, it was hoped, be properly cared for. As inhumane as this practice might appear it was a strategy forced upon families by government policy - a policy that the government did little to modify despite decades of protest from various doctors and magistrates.

Asylum officials scoffed at this process for another reason, which returns us to the conventional account. They complained that many families used the warrants as a means of abandoning helpless old people for which they no longer wished to care. They claimed that aged people who were merely "in their dotage" posed no threat to society and could, in most cases, be "easily cared for at home."(46) While it may have been true that most of these difficult to manage elderly people were suffering from the ravages of senile dementia and were not actually insane, this did not mean that they could be "easily cared for at home."

Senile old people regularly demanded far more care than most families could sustain either physically or financially. It has been argued that the term senile is merely "a medical expression of despair applied to socially isolated old people for whom nobody will accept responsibility."(47) While this may have been true in some cases, in most instances, the Rockwood asylum patients described as senile were truly ill and suffering from a disease which caused "a complete disruption of the personality" the result of which was that "eventually nothing of the patient's former personality (was) recognizable."(48) Often symptoms of paranoia, especially delusions of persecution and unrealistic jealousies caused a person to become unpredictable, violent, abusive, and frequently dangerous.(49) These, indeed, were the reasons the vast majority of the aged people in the Rockwood Asylum were sent there.

Almost all the aged people sent to the Rockwood Asylum between 1866 and 1906 were described as "uncontrollable," "violent to themselves or others," or "suicidal". Many were all three.(50) [ILLUSTRATION FOR FIGURE IV OMITTED] It is certain that these designations were, in some cases, exaggerations of the patient's actual condition. This does not mean, however, that the families did not have a legitimate reason for sending these people to the asylum. The fact that families and local officials sometimes lied about the actual "danger" certain aged people posed to society does not mean that they were not concerned for the well-being of that person. It merely indicates that families did what was necessary in order to conform to government policies and ensure that their aged kin received what was often the only form of care available to them.

The overall impression that emerges from these case-files is that rather than resorting to institutionalization at the first possible opportunity, nineteenth-century families used public institutions only as a desperate last resort,(51) usually only when violence was involved. As the Medical Superintendent remarked in 1879, "patients are retained at home as long as they can be managed by the members of the household, they are at last sent to the asylum when they have become violent."(52) Though a person's violence may have been exaggerated this does not mean most families were able to cope with the actual degree of unmanageability these people exhibited.

Uncontrollable, for instance, could mean that a patient required constant watching. This in itself could pose a major problem for many families. "Un controllable" could also mean that, aside from taking time and energy which many people did not have to spare, the care of a senile relative could prove emotionally taxing, frustrating, and disruptive to an entire family. Families were regularly forced to commit their aged kin to an asylum to preserve not only their financial security but also their emotional and even their physical well-being. Several people, for example, were prone to wandering out of their homes and disappearing, putting themselves in danger, frightening their families and often disturbing their neighbors. Ann, aged seventy-five, would wander three or four miles before her family could find her. She had to be watched constantly to keep her from breaking the furniture or harming herself. She was also fond of standing in front of trains. Her son and neighbors finally could not cope any longer and in 1888 they committed her.

Other patients posed greater problems. For instance, Jonathan, admitted to Rockwood in 1897, tore down his daughter's stove pipes, turned on the gas and tossed her clothing out the window. Thomas was even more destructive, breaking doors and windows, tearing down fences, and tearing up clothing. Yet another man, aged eighty, repeatedly tried to burn down his home with his family in it. Ellen, meanwhile, was sent to the asylum after her actions threatened to ruin her son financially by destroying his geese and damaging his apple trees.

More than merely being a nuisance, numerous patients were justifiably described as being "dangerous to their family and friends." The asylum doctors recognized that these people had become violent and abusive to the people around them. Most violence was focused on the very people who were doing the most to care for the ill person. This was the case with sixty-year-old Mary. Her husband tried to manage her for two years until she became so violent that he found that he could not sleep for fear his wife would kill him. Similarly, seventy-year-old Catherine suddenly took a strong dislike to the daughter who had been caring for her. She became increasingly threatening; the daughter was forced to commit her mother after Catherine attempted to harm her with a knife. In another instance, John began chasing his wife with a knife and driving her out of the house. After a short time she became too terrified of her husband to keep him at home.

Violent and unpredictable aged people were not only impossible to care for; the emotional trauma caused by their actions provoked serious rifts between other family members. One man was said to be "highly disturbing to all members of his family." His "familial home unit has been destroyed by his threatening mood." Gerald Grob explains that "the internal disruption of the family that followed certain forms of behavior ultimately reached a crisis stage." Once this occurred the "decision to commit the person causing the crisis rested on the belief that the welfare of the family as a whole had to take precedence."(53)

Even when a family was willing to keep an unmanageable relative at home this often became impossible once the person began to disturb their neighbors. As Cheryl Warsh explains, middle-class Victorians felt that families had a responsibility towards the community to control potentially bothersome kin. Disturbed individuals were not only a "cause of grief to their friends," they created "uneasiness and alarm" in the community.(54) If a family could no longer prevent a confused older person from becoming a nuisance to the neighbors they were often obliged to remove the offender to a place where he would not cause such problems.(55)

In several instances, the case files of elderly patients stress that they were sent for psychiatric care largely because their behavior had become intolerable to their neighbors and community. For instance, a Napanee man arrived at Rockwood after the community complained that he hung around and "disturbed the ladies and chased young children." One woman, meanwhile, was described as "plaguing the neighbors" because she wandered into strangers' homes at all hours and destroyed their property. Yet another patient was committed in 1891 after reports that he terrified his neighbors by firing a gun at them. In an even more dramatic example, sixty-five-year-old Charles was described as "a terror to the ladies of Belleville," after he "exceeded the bounds of propriety" and chased about the streets any handsome young women. Another patient was a "source of great disturbance to her neighborhood." The seventy-six-year-old woman ran from one home to another seeking protection from imaginary dangers. All these patients became more than just a concern to their families. They were obviously disrupting the daily lives of their entire community. At this point their families had little choice but to commit them.

In spite of the odds against keeping a senile relative at home, the Rockwood case files indicate that relatives regularly provided care for as long as they could, even once an aged person became demented and difficult to deal with. Letters to the administrators of the asylum from the families of patients confirm that many families made every attempt to retain their elderly relatives at home as long as possible and gave up their kin out of necessity, not choice.(56) Seventy-eight year-old Rebecca had been placed in the Hastings County jail in 1890 when she became violent and uncontrollable. Rather than have her sent to an asylum her daughter and son-in-law requested that she be released into their custody. Eventually, however, they too found her impossible to control and were forced to send her to Rockwood. One daughter had been her father's "constant attendant," but he was suicidal and had "put her through much distress" until she finally was forced to abandon her attempts to care for him at home. Eighty-year-old Mary became unmanageable, but when one relative could not care for her any longer, she was sent to another. It was not until her entire family finally discovered that "no-one can manage her," that she was sent to Rockwood.

Even after placing relatives in Rockwood, most families did not give up on them entirely or abandon them. Some families changed their minds out of guilt or merely because they had had a month or two of rest, and insisted that their kin be returned to them, sometimes against the advice of the asylum doctors. For example, Frederick was admitted to Rockwood in January 1889 as uncontrollable and suicidal. By May his family decided they wanted to care for him and took him home although "the doctors do not consider it a good idea." Some patients, such as William or sixty-nine-year-old Mary, were taken back by their families only to be returned a few months later when once again their families found them too difficult to manage. Other families took their kin out on two and three month probation periods.

All these cases offer proof that families did not abandon the aged in asylums. They used the asylum to help them cope with the terrible problem of supervising family members for whom they themselves could not care. Sometimes care-givers only needed a short respite before they felt able to resume their duties; others relied on the asylum but provided periodic care. Some families could only visit their kin. Though some families did eventually stop visiting their relatives in the asylum, this was often due primarily to the fact that asylum administrators made family members feel unwelcome since they did not appreciate or encourage family intervention in patient care.(57)

While families were willing to assist asylum doctors caring for their relatives, asylum officials were rarely willing to do the same for families. In some cases the asylum doctors insisted on releasing individuals to their family, especially if the patient was aged and considered simply a chronic case, even though the family insisted that they could not handle the person. The asylum officials would argue that the patient was "quiet and harmless" and did not need asylum care. John Walton reports that this practice was common in England where asylum officials tried to release quieter patients to workhouses or to the care of their families. Many of these patients "lost their tranquility" and had to be returned.(58) In Rockwood, William was one such case. He was admitted and discharged as "improved" several times only to be returned to the asylum a few months later by his family who insisted that he was not well. One explanation for this is that sometimes when a senile person takes a dislike to a particular person they only become deranged in the presence of that individual. Once away from their spouse or child or other family member, these people become calm. It does not seem, however, that Asylum officials were willing to accept that some people behaved differently around their family than they did around strangers. By releasing patients into the care of the very person or persons who caused them to become upset and frequently violent, officials caused a great deal of grief for both the patients and the hapless family members that had to deal with them.

The records of the very patients who were irresponsibly abandoned, according to the superintendents' reports, reveal that families regularly provided amazing amounts of care for their aged relatives, often under the most adverse circumstances. Spouses, children, and siblings regularly exposed themselves to a life of "continual danger, dreadful anxiety, and the necessity of constant watching,"(59) in an attempt adequately to safeguard their ill and dependent aged relatives. If these individuals sometimes failed, they should not be judged harshly for being unable to provide for all the needs of aged persons who required not only extraordinary amounts of care but care of a specialized nature which was well beyond the means of most nineteenth-century families and indeed remains beyond the capabilities of most families today.

The evidence from the case-files of the aged patients of the Rockwood Asylum for the Insane in Kingston, Ontario, therefore, indicates that families did not abandon the aged in institutions to be rid of them. Instead, it appears that the asylum was, as John Walton and Gerald Grob have argued, a final resource for desperate families. While government documents support the claim that asylums were employed as an easy option for the uncaring or irresponsible,(60) these reports were presented to support government policies of fiscal restraint rather than to report on the true situation of nineteenth-century families.

Department of History Ottawa, Ontario, Canada K1N 6N5

ENDNOTES

The author wishes to thank Hester Ascah and the staff of the Ontario Archives, especially Stormi Stewart, Leon Wormski, and Karen Bergsteinsson.

Abbreviations:

AO = Archives of Ontario

AR = Annual Report of the Inspector of Prisons and Public Charities for the Province of Ontario - Upon Asylums (Brackets indicate the particular asylum report found in the appendix of the inspector's report)

RG = Record Group

1. This term was coined by Andrew Scull in "A Convenient Place to Get Rid of Inconvenient People: The Victorian Lunatic Asylum," in Buildings and Society, ed., A.D. King (London, 1980), pp. 37-60.

2. Richard Fox, So Far Disordered in Mind: Insanity in California, 1870-1930 (Los Angles, 1978), p. 139.

3. John Walton, "Lunacy and the Industrial Revolution: A Study of Asylum Admissions in Lancashire, 1848-50," Journal of Social History 13 (1979-80): 17.

4. John Walton, "Casting Out and Bring Back in Victorian England: Pauper Lunatics, 1840-70," in The Anatomy of Madness: Essays in the History of Psychiatry, Vol. II, eds., W.E Bynum, Roy Porter, and M. Shepherd (London, 1985), p. 135.

5. AR (1899), Appendix (Hamilton), p. 126.

6. Thomas Brown, "Living with God's Afflicted: A History of the Provincial Lunatic Asylum at Toronto, 1838-1911," (Ph.d Thesis; Queen's University, 1981), p. 24; also see AR (1893), appendix, (Toronto), p. 6.

7. AR (1896), Appendix, (Hamilton), p. 127; and AR (1897), Appendix, (Kingston), p. 94.

8. AR (1899), Appendix, (Hamilton).

9. AR (1898) Appendix, (Hamilton), p. 151.

10. AR (1897) Appendix (Kingston), p. 93.

11. AR (Brockville) 1903, p. 129.

12. Richard Fox, So Far Disordered in Mind, p. 132.

13. AR (1896), Appendix, (Mimico), p. 191.

14. Andrew Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth. Century England (London, 1979), p. 245.

15. See AR (1898), Appendix (Brockville); AR (1897), Appendix (Brockville), p. 211 and (Toronto).

16. AR (1862), Appendix (Rockwood).

17. See AO: RG 10-2-F, MS 717, reels 1-5. Between its opening and 1899 there were 2,754 patients treated; all these case files were available. Between 1900 and 1907 a further 1,405 people were treated at the asylum. However, while the case files before 1900 are complete for both the male and female patients, after that date the male files are not complete. After 1905 the female files are missing certain cases. While the actual number of cases can be determined from the Annual Reports of the Asylum, the case records for certain files cannot be located. For this reason the totals used in the calculations that follow are based not upon the total number of cases treated at the asylum but upon the total number of case files located. The number of missing case files, especially files that pertain specifically to the aged is small and it there is no reason to assume that the results of these calculations differ in any significant way from the figures that would have been obtained had the complete series case files been available.

18. AR (1893), Appendix (Toronto) p. 1.

19. This assertion is also supported by the notes of nineteenth-century doctors who signed certificates for admission to asylums. See, for instance, Jacalyn Duffin, Langstaff: A Nineteenth-Century Medical Life (Toronto, 1993), pp. 127-30.

20. Peter Ward, Love, Courtship and Marriage in Nineteenth-century English Canada (Montreal, 1990), pp. 51-52.

21. Emily Abel, Who Cares for the Elderly? Public Policy and the Experiences of Adult Daughters (Philadelphia, 1991), p. 31.

22. These figures are calculated using information from all case-files for the entire period between 1866 and 1906. Due to the small number of files in some periods it is not possible to produce family-care statistics which would permit one to determine change over time; only aggregate figures are possible.

23. D. Hack Tuke, The Insane in the United States and Canada (Chicago, 1973) (Reprint of original 1885 publication); see report on Kingston Hospital.

24. John Walton, "Casting Out and Bring Back," p. 134.

25. Ann Shola Orloff, The Politics of Pensions: A Comparative Analysis of Britain, Canada and the United States, 1880-1940 (Madison, WI, 1993), Chapter 3.

26. Michael Katz, Michael Doucet and Mark Stern, The Social Organization of Early Industrial Capitalism (Cambridge, 1982), Chapter 3.

27. Cheryl Krasnick Warsh, Moments of Unreason: The Practice and Canadian Psychiatry and the Homewood Retreat, 1883-1923 (Montreal, 1987), pp. 71-73.

28. "Keep Up the Family Attachment," Perth Courier (September 27, 1872).

29. Warsh, Moments of Unreason p. 71.

30. Agnes Hatfield, "Families as Caregivers: A Historical Perspective," in Families of the Mentally Ill: Coping Adaptation, eds, Agnes Hatfield and H. Lefley (New York, 1987), p. 4; and Emily Abel, Who Cares for the Elderly? p. 29.

31. Emily Abel, Cares for the Elderly? p. 31; also see P.A. Pollett, I. Anderson and D.W. O'Connor, "For Better or For Worse: The Experience of Caring for an Elderly Dementing Spouse," Ageing and Society vol. 2 (1991): 457.

32. Wendy Mitchinson, "Gender and Insanity and Characteristics of the Insane: A Nineteenth-Century Case," Bulletin Canedienne d'histoire de Medicine/Canadian Bulletin of Medical History, 4, no. 2 (winter 1987): 97-117.

33. Report of the Medical Superintendent of the Toronto Asylum for the Insane, Journal of Legislative Assembly of the Province of Canada, Appendix 12: found in Brown, "Living with God's Afflicted," p. 179.

34. Horatio Milo Pollock, Family Care of Mental Patients (New York, 1976) (reprint of 1936 original), p. 44.

35. Idris Williams, Caring for the Elderly in the Community (London, 1989), p. 219.

36. Richard Fox, So Far Disordered in Mind, p. 97.

37. Richard Fox, So Far Disordered in Mind, p. 11.

38. Agnes Hatfield, "Families as Caregivers," p. 4.

39. See The Report of the Medical Superintendent of the Provincial Lunatic Asylum at Toronto in the Journal of the Legislative Assembly of the Province of Canada, 1857, Appendix 12; found in Brown, "Living with God's Afflicted," p.179; also Richard Fox, So Far Disordered in Mind, p. 44.

40. AR (1866).

41. AR (1891), Appendix (Toronto), p. 9; also Wendy Mitchinson, "Gender and Insanity," p. 102.

42. AR (1882), Appendix (Kingston).

43. Charlotte MacKenzie, "Social Factors in the Admission, Discharge and Continuing Stay of Patients at Ticehurst Asylum, 1845-1917", in The Anatomy of Madness: Essays in the History of Psychiatry, vol. II, eds., W. F. Bynum, Roy Porter and M. Shepherd (London, 1985), p. 155 (she reports that the shame experienced by Victorian families when one of their members became mentally disturbed could be very intense).

44. Thomas Brown, "Living with God's Afflicted," p. 108.

45. AR (1899), p. 101.

46. See various files in AO:RG 10: Series 20-F-1.

47. Michael Meacher, Taken for a Ride: Special Residential Homes for Confused Old People: A Study of Separatism in Social Policy (London, 1972), p. 40.

48. Lance Tibbles, "Medical and Legal Aspects of Competency as Affected by Old Age," Aging and the Elderly: Humanistic Perspectives in Gerontology, eds. Stuart Spicker, Kathleen Woodward and David Van Tassel (Atlantic Highlands, NJ, 1978), p. 129; and also Idris Williams, Caring for the Elderly, p 219.

49. Idris Williams, Caring for Elderly People, p. 220.

50. Of all persons over the age of sixty admitted to Rockwood between 1858 and 1906, 52% were described as uncontrollable, 40% as dangerous or violent, 22% as suicidal, and 7% were listed as exhibiting signs of all three.

51. John Walton, "Casting Out and Bring Back," p.141; Jacalyn Duffin, Langstaff, see Chapter 6.

52. AR (1879): p. 351.

53. Gerald Grob, "Abuse in American Mental Hospitals in Historical Perspective: Myth and Reality," in Sickness and Health in America: Readings in the History of Medicine and Public Health, eds. Judith Leavitt and Ronald Numbers (Madison, 1985), p. 301.

54. Barbara Rosencrantz and Maris Vinovskis, "The Invisible Lunatics: Old Age and Insanity in Mid-Nineteenth-Century Massachusetts," in Aging and the Elderly, eds., Spiker, Woodward and Van Tassel, p. 120.

55. Cheryl Marsh, Moments of Unreason, pp. 71-73.

56. For further evidence of this see Jacalyn Duffin, Langstaff, p. 133.

57. Agnes Hatfield, "Family as Caregivers," p. 5.

58. John Walton, "The Treatment of Pauper Lunatics," p. 189.

59. Richard Fox, So Far Disordered in Mind, p. 46.

60. John Walton, "Casting Out and Bring Back," p. 141.