For a Canadian psychiatrist, this history of psychiatry in the second largest country in the world (in area if not in population) is a must-read, commemorating the 50th anniversary of the Canadian Psychiatric Association. (Before 1951, Canadian psychiatry was a stepchild of APA.) The editor, Dr. Quentin Rae-Grant, who is also editor-in-chief of the Canadian Journal of Psychiatry, provides an excellent introduction to a somewhat arbitrarily selected history, rich in content and beautiful to look at.
The beauty lies mainly in the cover, a stunning wrap-around reproduction of a bright-colored multiplane cityscape by Toronto artist Alan Parker. Mr. Parker describes the original painting as a view from his studio window and calls it The Measure of the Real, an apt name for the cover of a book about psychiatry. The artist, whose photograph is on page 297 of the book, is a star. His immense talents have allowed him to overcome serious psychiatric difficulties, and, in this sense, he speaks to the success of Canadian psychiatry more eloquently than do the 50 years of accomplishments detailed in the book.
These accomplishments are important and well told. Because Canada is bilingual, this mainly English-language book contains a chapter in French about the history of psychiatry in Quebec, a province that arguably has contributed more than Canada’s other regions to psychiatric advances and, as several chapters mention, misadventures as well. The overview historical chapters are very informative, as are the specifics on practice patterns, funding patterns, workforce planning, mental health reform, psychotherapy, advocacy, education, psychopharmacology research, epidemiology, and genetics. There is even an ambitious chapter attempting to predict the future of psychiatry in Canada.
Many comparisons with the United States are sprinkled throughout the book, which will be of interest to American readers. The book does not situate Canadian psychiatry on the world stage, however. Much of the material is parochial and of minor concern to non-Canadians. What might have been tantalizing stories, if told in greater detail, are glossed over. What could be major Canadian contributions to psychiatric science, if embedded in an appropriate context, are barely mentioned. What are acknowledged model Canadian mental health intervention programs are omitted.
As the epigram to the first chapter says, “History is always written wrong, and so always needs to be rewritten” (Santayana). In 50 more years, the names and institutions mentioned in the book will doubtless be forgotten, but the quirky view of life in the modern city, as seen through the eyes of artist Alan Parker, will stand as a symbol of the structures and fault lines that constitute Canadian psychiatry.
