TPH: History and Memories of the Toronto Psychiatric Hospital, 1925–1966

Edward Shorter is a historian who specializes in the history of psychiatry. One would wish he had given this slim volume a less local title because its contents are of broad interest to the mental health professions as well as to the general reader. This book would be of special interest to readers of The American Journal of Psychiatry because most of the chapters of this multiauthored book revolve around a central character, Clarence B. Farrar (1874–1969), who was not only the Director of the Toronto Psychiatric Hospital (and University Chair of Psychiatry) from 1925 to 1947 but also the eighth Editor-in-Chief of the Journal, from 1931 through 1965. In a journal whose editors have all enjoyed felicitous longevity, C.B. Farrar has out-tenured and outlived, thus far, everyone. In his 91st year, Farrar was replaced by Francis J. Braceland as Editor-in-Chief; he served 4 more years as Editor Emeritus until his death at age 95. The C.B. Farrar Archives, maintained by his widow, Joan Farrar, contain every issue of The American Journal of Psychiatry from its inception in 1844 as The American Journal of Insanity.

In his chapter describing Farrar’s association with the Journal, extending from 1927 to 1969 in all, Peter Faux describes the evolution of North American psychiatry during a historical period of tidal changes. A side note of interest: The American Journal of Insanity became The American Journal of Psychiatry, volume 1, in 1918. In 1933, it was at volume 15. Farrar changed it to volume 91 in 1934, reinstating its historical heritage.

According to Faux, Farrar worked 7 days a week at editing. He rarely used the telephone, preferring to correspond in writing. An American, Farrar was apparently always viewed with suspicion by Canadian Customs officials, who regularly censored the volume of suspicious incoming foreign mail addressed to the editorial office. Five boxes of Farrar’s correspondence are currently housed in the APA Archives. Faux sums up Farrar’s criticism of American psychiatry during this period as “sharply divided into…schools, centered on prominent men with distinctive views,” an appraisal that, 40 years later, appears precise and accurate. On psychotherapy, Farrar wrote a classic article in 1957 (1) in which he included a vignette of John Stuart Mill being cured of mental disorder by reading a Wordsworth poem. Farrar concludes with the message, quoted from Anatomy of Melancholy (his style was to hide behind other men’s words), “He doth the best cures, according to Hippocrates, in whom most trust,” a truth to make twenty-first-century American psychiatry pause.

There is much to reflect on in this volume besides the wisdom, in his maturity, of Farrar. Initially, he was very much caught up in the vogues of the day: S. Weir Mitchell’s rest cure (isolation from family, bed rest, milk diet, massage, electroshock); Paul Dubois’ psychotherapy of rational persuasion; “resting” jackets for menstrual “excitement”; Henry Cotton’s surgical cures of “reflex” problems (removing teeth, uteri, colons); the eugenics movement (sterilization of “mental defectives”); warm baths; insulin coma; Metrazol shock; leucotomy. He was not, however, caught up with Freud: “the shadows of Freud linger as the last touch of mysticism in medicine.” This disbelief became a problem for Farrar’s reputation when, by the 1950s, the chairs of all the best psychiatry departments in the United States (although not Canada) were psychoanalysts.

This book is multidisciplinary, with contributions from all mental health professions and from a patient. The chapter by Peter Keefe, which sets a patient’s memories beside excerpts from her hospital chart, is brilliant and beautifully written. Although intended to commemorate Toronto Psychiatric Hospital as a model of interdisciplinary harmony, the book demonstrates by its contents and its emphases the ascendancy of psychiatry over other mental health disciplines. This has not changed much over the years. In sum, the story of the birth and death of Toronto Psychiatric Hospital, as portrayed in these pages, is the story of psychiatry, concealing its adolescent embarrassments under progressive layers of modified nomenclature, geographic moves, administrative changes, philosophical revisions, and procedural renewals but retaining inexplicably its nostalgia for an idealized past.