L’Institut universitaire en santé mentale de Québec – Work Therapy

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While leisure pursuits were seen as therapeutic because they interrupted the monotony of life and distracted patients from frenzied ideas, many doctors recommended that patients also work, because it would have the identical effect and be equally good for the patients’ minds.1 Doctors believed that work was the first step in a patient’s recovery. It was advised because it fostered the individual’s disalienation and resocialization and made him or her feel like a useful member of society. It got patients accustomed to regular hours, and work loads were increased gradually, helping them adapt to the world they would be going back to.But in spite of the proliferation of the kinds of work patients did and the benefits obtained, work therapy also had some problems. In the 1870s, work therapy decreased at the Asile des Aliénés de Québec because of a lack of supervisory staff. At this time, the asylum was also directed to be a money-making institution, and moral treatment was very costly. To cut costs, the owners reintroduced treatments that had for the most part been abandoned – isolation and restraint – in spite of the plans to create a broad-scale moral treatment project in 1874-75. This project included a work component: gardening, a knitting workshop, sewing, woodworking, shoemaking, a bakery, maintaining the slaughterhouse, the pig farm and the stables, and a leisure component: dancing, walks, picnics, theatre, concerts, public entertainments, circuses, illustrated lectures, parlour games and singing. In spite of this, it appears that the plan was never implemented, because an 1880 report from the inspectors states that only about twenty patients were doing activities that could be considered moral treatment. But a moral treatment plan was implemented in the early 1880s because they could actually see the benefits.2Starting in 1845, patients were set to work hoeing, gardening, and cutting and splitting wood. In winter, they cleared snow and broke rocks. In 1894, Doctor Arthur Vallée, (B15-B-15a) the medical superintendent at the Asile des aliénés de Québec from 1893 to 1903, stated that over 75% of the men in the hospital were working on repairs to the hospital’s buildings. The women were making new clothing, sewing, weaving and knitting. (B16-B17-B18-B19-B19-a) In 1897, the hospital had two workshops for making brushes, in which a great many patients worked. These workshops were very productive and, in that same year, outside businesses complained of unfair competition, although their merchandise was sold for the going market price.3 This was also the period when they began to make extensive use of workshops at the Asile des Aliénés de Québec. (B20-B21)The benefits of moral treatment are so significant that this kind of treatment is still used today, in spite of changes and developments made over time.4 The appearance of drugs did not completely eliminate recreation and work; new programs were put in place. With regard to recreational therapy, in 1968 a graphic expression project was set up to help subjects arrive at a better understanding of their problems through what they did in the workshop, discover unsuspected personal skills, and express themselves more spontaneously. The Émile-Nelligan centre was created in the 1970s for the purpose of teaching socially acceptable behaviour and helping patients get in touch with reality through form, concrete materials, objects and the environment. Occupational therapy and the crafts program were used along with graphic expression.5Animal therapy was introduced at Hôpital Saint-Michel-Archange at this time, and used for physical and psychogeriatric care. Small animals and birds were kept in an area called Le Bosquet, the grove.6 Work therapy also developed over time and the kinds of work increased. Some of the types of work done in the 1970s were for industrial contracts for manufacture of sheds and dish and floor mops; shampoo bottling; preparation of vegetables and culinary preparation; activities related to printing; manufacture of envelopes; assembly, folding and binding of documents; message services; laundry; and reception of merchandise. With this great diversity, they were able to attract and satisfy more patients.The goals of moral treatment, which has proved its worth many times since 1845, have with time been defined and clarified. In about 1960 the aims of moral therapy (which had become milieu therapy) were confirmed: to bring patients close to nature and away from their pathological environment; turn their minds away from morbid thoughts; give them an ordered, structured environment; encourage contact with “intelligent” people to improve their social skills; and give them the latitude to express their individual tastes.7 In short, this therapy was intended to restore a social and occupational life to patients, without making them aim for a perfect re-entry into society, which it was believed would put too much pressure on them.We can see then that moral treatment, which was used right from the foundation of psychiatric hospitals, has evolved over the years. Doctors immediately understood its beneficial effects and it was developed and improved over time. This moral treatment was part of a process of institutionalization of psychiatry and it had a vital role to play, since even with the arrival of drugs, which seemed revolutionary at the time, moral treatment would continue to be used in all hospitals. The era of treating mental illness in the same way as any other physical disease began.

1. Hubert A. Wallot. op.cit., p. 108.
2. Normand Séguin. op.cit., p. 48.
3. Jules Lambert. Mille fenêtres. Éditions Centre hospitalier Robert-Giffard, Beauport, 1995, p. 34.
4. Today, recreation and work are still considered to be beneficial, both for those with mental illness and for the rest of society.
5. Jules Lambert. Mille fenêtres. op.cit., p. 129.
6. Ibid., p. 147.
7. Hubert A. Wallot. op.cit., p. 115.

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