This Element's contribution explores the historiography of madness in the Modern era, including landmark publications in the overlapping fields of the history of psychiatry and the history of lunatic asylums. As this examination of almost 200 academic works will demonstrate, the field is vast and highly contested, with researchers sometimes disagreeing about the basic terms of analysis. Nevertheless, from Foucault to Fanon, from Goffman to Gilman, these debates about social and medical responses to madness have inspired some of the most influential academic scholarship of the twentieth century. This title is also available as Open Access on Cambridge Core.

In countries where assisted dying is legal, the relationship between this practice and suicide often raises concerns. In Canada, the issue has been particularly contentious in the context of policy debates about the permissibility of assisted dying for persons with mental disorders. The problem is often formulated by asking whether an assisted death by a person with a mental disorder is different from suicide. This question depends on two related assumptions: 1. suicide is a sign of mental disorder and 2. suicide is a descriptive term that picks out an empirically decidable state of affairs. These assumptions – and therefore the question upon which they are based - have generated considerable and unresolved debate. In this paper, we explore these assumptions. Suicide and assisted dying are both intentional acts to end one’s life. We argue that when a certain form of intentional ending of one’s life is negatively evaluated, it is called a suicide. When it is not negatively evaluated, it is described in other terms. We contend that asking whether an assisted death by a person with a mental disorder is different from suicide is really just asking whether an assisted death by a person with a mental disorder is negatively evaluated or not, rather than whether they are different in some empirically decidable way.

It has been fifty years since the publication of A New Perspective on the Health of Canadians, a Green Paper circulated under the name of then Canadian federal Minister of Health and Welfare, the Honourable Marc Lalonde. Since its publication in 1974, the Lalonde Report, as it is commonly known, has been credited with launching a new era of health promotion, with a sustained focus on the social determinants of illness, disease, and disability. It was also surprisingly influential, breaking new ground for other international accords. At the same time, it has garnered a certain amount of criticism for its emphasis on individual responsibility for health outcomes, with some researchers sensing a neo-liberal agenda that occluded structural and environmental contributions to health inequities. At a time when Canadians are again debating the future of a health care system, this Introduction and the historical articles that follow aim to place the Lalonde Report in its political, social, and epidemiological context. It will provide a much-needed reflection on one of the most important public policy documents in contemporary Canadian history.

Suicide rose in importance as a major public health concern in post-war Canada, concurrent with the relative decline of infant and childhood mortality and the rise of the behavioural sciences. In response to a perceived crisis in suicides during the 1960s and 1970s, a new technology-the rotary telephone-was reconceived as a "therapeutic instrument" to reach people in crisis. Voluntary and religious groups began establishing "suicide hotlines" across the country as a participatory public health intervention aimed at saving lives. However, as suicide rates continued their seemingly inexorable rise, suicide hotlines witnessed a discursive transformation, away from a goal of reducing suicide rates and toward mental health crisis intervention more broadly.

Reviewed by: Andrew Fernando Holmes: Protestantism, Medicine, and Science in Nineteenth-Century Montreal by Richard W. Vaudry David Wright Richard W. Vaudry. Andrew Fernando Holmes: Protestantism, Medicine, and Science in Nineteenth-Century Montreal. Toronto: University of Toronto Press, 2020. viii + 390 pp. Ill. $60.00 (978-4875-0219-5). Andrew Holmes may not be a household name to many medical historians, but he was the principal founder of Canada’s first medical school. The Montreal Medical Institution, later McGill University’s Faculty of Medicine, would become one of the most influential medical schools in the English-speaking world, boasting such notable faculty members as William Osler and Wilder Penfield. In this exhaustively researched biography, Vaudry charts the life and times of Holmes, from medical apprenticeship in colonial Montreal, to formal university-based training in Edinburgh, clinical internship in Paris, and finally returning to be one of McGill’s first deans of medicine. So central was Holmes to the foundation of medical studies at the so-called Harvard of the North, that the gold medal for academic achievement in medicine at McGill is named after this evangelical physician. Vaudry anchors the career of Holmes in the turbulent economic and political times of Montreal during the first half of the nineteenth century. It was during this era that this small town, founded during New France and lying at the confluence of the St. Lawrence and Ottawa rivers, began to emerge as the principal commercial center of Lower Canada. After the British conquest, it boasted a small, but powerful, Anglo-Scottish commercial elite, a large working-class French-Canadian Catholic majority, and, by the 1840s, an impoverished Irish population fleeing the Famine. Sectarianism would be the dominant divider in the rapidly growing city, leading to separate schooling, separate religious communities, and, most relevant to this book, separate hospital systems. The creation of the Montreal Medical Institution and its affiliated Montreal General Hospital in the 1820s were thus not simply an attempt to modernize medical education and clinical practice in an unusual corner of the British Empire; it was also a noteworthy symbol of Anglo-Protestant dominance in pre-Confederation Canada. Medicine at McGill has long been associated with the Scottish tradition of medical education, which, in the early 1800s, had become the gold standard in clinical techniques and novel pedagogies. The medical schools of Edinburgh and Glasgow, in particular, were destinations for students travelling from the four corners of Empire. In Edinburgh, Holmes sought qualifications as a surgeon while pursing the increasingly desirable university designation of M.D. Vaudry paints a rich portrait of the culture of medical education in Edinburgh in the 1810s, where institutional nepotism and competition from extramural lecturers engendered a fluid medical environment, and where lively urban societies provided valuable opportunities for networking and socialization. He highlights how Holmes, and many of his fellow Canadian students, drew additional experience from their sojourns in Paris, where they found inspiration in French clinicians’ attempts to reconcile the often feuding surgical and medical branches of the profession. Indeed, the unusual McGill dual designation of MDCM (doctor of medicine and master of surgery) symbolized this hope for a unified future. [End Page 271] As the rather lengthy title suggests, Vaudry illuminates the multifaceted aspect of Holmes’ life, not only as a doctor but also as a Protestant evangelist and amateur natural scientist. Holmes clearly had diverse intellectual preoccupations, devoting as much time to his mineralogical collections and advancing evangelical causes as he did promoting the new medical school at McGill. For historians of medicine, a chapter on Holmes’s life as a medical lecturer, in the generation just before the advent of “scientific medicine,” serves as an excellent case study of the pluralism of medical practice at mid-century. Holmes combined older “heroic” techniques—from bloodletting to blistering—with new instruments and techniques of mid-century, including the stethoscope and chloroform. Occasional published research—such as his various papers on cardiac abnormalities—led to the eponymous appellation of the Holmes heart. In summary, this book offers a useful addition to our understanding of the early years of Canadian medicine and medical schools, one which avoids the too-often triumphalist approaches that lionize great...

The history of madness remains one of the most fascinating and contested fields in modern social history. For several decades, scholarship has focussed on analysing the rise of the lunatic asylum and the new profession of psychiatry that was forged within its walls. Individuals diagnosed as insane were largely considered passive victims of social forces beyond their control. However, a new generation of scholarship has sought to de-centre the asylum and reconceptualise the 'mad' as historical actors with agency who had troubled lives outside of the formal institution. This article reflects on some major themes in the English-language historiography of madness over the last forty years, at the same time placing some Australian scholarship within that wider context throughout the narrative and in references. It highlights how, paradoxically, histories of the lunatic asylum have provided new insights into extramural care, the persistence of non-medical discourses about insanity, and the subjective experiences of the insane. Rather than 'out of sight and out of mind' - an historical topic resting on the periphery of modern social history - this new literature on the history of madness and the asylum illustrates how psychological distress was a mainstream social problem that upended family relations and profoundly disrupted community life.

In the 150 years leading up to World War I, lunatic asylums became the largest and most controversial medical institutions in the Western World. It is within these facilities that the discursive formulations and clinical practices that eventually became known as “psychiatry” took shape. Over the course of the 1800s, asylum medical officers underwent a decades-long process of professionalization – creating national associations, founding journals devoted to the study of mental diseases, and finally integrating “psychological medicine” into university medical training. The legal requirements of medical certification and the institutional bureaucracies of record keeping created the foundations upon which new taxonomies of mental illness were first constructed. This chapter outlines the institutional origins of psychiatry as a human science, focusing on what historians refer to as the “long” nineteenth century – that is, the period from 1760 to 1914.

The post-Second World War era witnessed a dramatic surge in the transnational migration of doctors and allied healthcare practitioners. During the 1960s in particular, a combination of immigration reform and the expansion of health infrastructures in North America and Western Europe unleashed a pent-up demand for medical and nursing care that led to the relocation of tens of thousands of doctors and nurses from so-called 'developing' to 'developed' countries. This paper examines the Canadian province of Newfoundland as a case study of this larger global phenomenon. It analyzes the composition of the Newfoundland medical workforce between 1950 and 1976 through a variety of sources - in particular, contemporary Canadian and American medical association directories. This quantitative analysis is supplemented by qualitative sources, including obituaries of Newfoundland doctors in the Canadian Medical Association Journal, reports published in the British Medical Journal, and the testimony of Newfoundland stakeholders and organisations to the Canadian Royal Commission on Health Services (1961-1964). As this paper demonstrates, the majority of the foreign-trained doctors registered in Newfoundland in the 1950s had received their training in Britain and Ireland. Many stayed for short periods of time, remigrating to other parts of the country, or to the United States. By the early 1970s, however, the doctors trained in the British Isles were complemented by physicians and surgeons from the Middle East, from South Asia, and from East Asia, a pattern that reflected trends across the Commonwealth and the United States. This article thus provides insights into the dynamics of global post-war medical migration and professional pathways, attending to the immigration reforms and sociopolitical changes in receiving countries amidst political upheaval in countries of origin.

Reviewed by: Brève histoire des épidémies au Québec: Du choléra à la COVID-19 by Denis Goulet David Wright Goulet, Denis –Brève histoire des épidémies au Québec: Du choléra à la COVID-19. Québec: Septentrion, 2020. Pp. 172. In 1847, amid an emerging typhus epidemic, the public health authorities of Montréal frantically built fever sheds along the Saint Lawrence River to care for and contain infected Irish immigrants debarking from dozens of ships. Sanitary police were called in to act as a barrier to prevent the potentially contagious from escaping the scenes of misery under cover of darkness. Amid the palpable tensions, the Grey Nuns and the newly formed Sisters of Providence selflessly tended to the sick crammed into makeshift barracks, hundreds of whom would succumb in short order to what was known as "ship's fever." The Bishop of Montréal descended upon the dying to deliver last rites to his coreligionists before they were buried hastily in mass graves. Ultimately, several thousand died in the scorching heat of July and August of that year, including, as the epidemic inevitably spread throughout the city, the Mayor himself. The great typhus disaster is but one of the principal epidemics showcased in this informative "brief history" of epidemics in Quebec. The book is divided into two principal parts: the first covers the period from the cholera pandemic of 1831–1832 to the smallpox epidemic of 1885; the second begins with the Spanish flu of 1918 and concludes with the arrival of AIDS in the 1980s. The echoes of past responses to epidemics will no doubt resonate with readers living through the current COVID-19 crisis. Cholera prompted the installation and formalization of quarantine protocols; the typhus epidemic encouraged the establishment of municipal health boards; the smallpox riots of 1885 reflected the longstanding suspicion of, and resistance to, compulsory vaccination. Despite the implementation of sanitary reform and discoveries associated with "scientific medicine," the remedies of mainstream medicine were often insufficient. The 1918 Spanish flu revealed the limitations of the bacteriological revolution; the decennial polio outbreaks highlighted our growing preoccupation with technological solutions (such as the iron lung); and AIDS demonstrated how effective therapeutics and vaccines sometimes take years, indeed decades, to develop. Brève histoire des épidémies provides an accessible compendium of many of the prominent infectious disease outbreaks in the history of Quebec after the conquest. It will be of particular value to a general public eager to dip into medical history and to peruse the captivating stories of sacrifice, suffering, and scapegoating in the past. Readers, for example, might be surprised to learn that more residents of Quebec city died of cholera in 1832 than COVID-19 in 2020, despite the fact that the city's population was, in 1832, one-tenth of what it is today. The book's strongest contribution may lie in its careful analysis of the construction of Quebec's public health infrastructure over the last two centuries. Who knew that the Rockefeller Foundation, so active in Latin America, also played a pivotal role in funding unites sanitaires across the province during the interwar period? For academic historians, there are, of course, some downsides to emphasizing only the major epidemic outbreaks of the past two centuries. It is easy to forget that the biggest infectious disease killer of the 1800s was actually tuberculosis, which was so widespread as to [End Page 200] be considered endemic. What is more, the very high death rates from nonepidemic diseases of urban capitalism—"summer diarrhoea," measles, and "enteric fevers"—merit relatively little attention, even though Montréal had the dubious reputation of boasting the highest rates of infant mortality in the Western world in the decade leading up to the First World War. Nevertheless, this is a readable and accessible book that conveys technical aspects of disease transmission very clearly while maintaining a sensitivity to the diverse cultural and social aspects of epidemic outbreaks. Goulet demonstrates vividly how societal responses were often pluralistic, with some people placing faith in medical science and the power of government to do good, whilst others were more skeptical of the motives of medical men and...

Radical Medicine examines the pre-history of Canadian Medicare, looking at the circulation of ideas about socialist medicine as they made their way from Europe, via Britain, and ultimately into North America.