Editorial Credits/ Crédits éditorials

Subscription Rates /Prix d'abonnements

Advertising Rates / Tarifs publicitaires (PDF)

Editorial
Canadian Journal of Psychiatry: New Editor and New Policies
Joel Paris, MD
(PDF)

Guest Editorial
Risk Assessment in Psychiatric Practice
Kenneth Hashman, MD, FRCPC, DABPN
(PDF)

In Review
The Canadian Contribution to Violence Risk Assessment: History and Implications for Current Psychiatric Practice
Hy Bloom, LLB, MD, Christopher Webster, PhD, Stephen Hucker, MB, Karen De Freitas, MD
(PDF)

The Clinical Use of Risk Assessment
Graham D Glancy, MB, ChB, FRCPsych, FRCPC, Gary Chaimowitz, MB, ChB, FRCPC
(PDF)

The State of Contemporary Risk Assessment Research
Michael A Norko, MD, Madelon V Baranoski, PhD
(PDF)

Review Paper
Community Treatment Orders: Profile of a Canadian Experience
Ann-Marie A O’Brien, MSW, RSW, Susan J Farrell, PhD, CPsych*
(PDF)

International Dosage Differences in Fluoxetine Clinical Trials
Scott Patten, MD, Andrea Cipriani, MD, Paolo Brambilla, MD3, Michela Nosè, MD, Corrado Barbui, MD
(PDF)

Original Research
Panic-Agoraphobic Spectrum and Light Sensitivity in a General Population Sample in Italy
Letizia Bossini, MD, Mirko Martinucci, MD, Katia Paolini, MD, Paolo Castrogiovanni, MD
(PDF)

Psychotic Disorders Clinic and First-Episode Psychosis: A Program Evaluation
Suzanne Archie, MD, FRCPC, Jane Hamilton Wilson, RN, Kevin Woodward, BSc, Heather Hobbs, RN, Shelley Osborne, RN, Jean McNiven, RN
(PDF)

Screening for Mild Cognitive Impairment: Comparing the SMMSE and the ABCS
D William Molloy, MB, MRCPI, FRCPC, Timothy IM Standish, David L Lewis, PhD
(PDF)

Attention-Deficit Hyperactivity Disorder With and Without Obsessive–Compulsive Behaviours: Clinical Characteristics, Cognitive Assessment, and Risk Factors
Paul Daniel Arnold, MD, FRCPC, Abel Ickowicz, MD, FRCPC, Shirley Chen, MD, MPH, Russell Schachar, MD, FRCPC
(PDF)

Brief Communication
Validation de la version française de l’inventaire de détresse péritraumatique
Louis Jehel, MD, PhD, Alain Brunet, PhD, Sabrina Paterniti, MD, PhD, Julien D Guelfi, MD, Pr
(PDF)

Book Reviews
(PDF)

The Confinement of the Insane: International Perspectives, 1800–1965
Review by
Laurence Jerome, MD

Suicide in Children and Adolescents
Review by
Paul S Links, MD, FRCPC

Letters to the Editor
(PDF)

A Novel Form of Treatment Resistance in Anorexia Nervosa

Capgras Syndrome in the Modern Era: Self Misidentification on an ID Picture

Effectiveness of Risperidone in Delirium

Family-Oriented Rehabilitation for Unexplained Chronic Pain

Hypokalemia from Risperidone and Quetiapine Overdose

A Renewed Interest in Day Treatment

Quetiapine Therapy for Corticosteroid-Induced Mania

Book Review

History of Psychiatry

The Confinement of the Insane: International Perspectives, 1800–1965. Roy Porter, David Wright, editors. Cambridge (UK): Cambridge University Press; 2003. 371 p. US$70.00.

Review by:Laurence Jerome, MD
                London Ontario

This scholarly work exemplifies the best traditions of history of medicine research. It gives the reader a global perspective on the asylum’s evolution from the 1800s to the end of the 20th century, incorporating 14 essays that cover its history in various locations throughout the world. Included are essays from Europe, the US, Canada, Argentina, Mexico, India, and Nigeria.

This book analyzes in depth the demographic, social, and political factors that shaped the evolution of the asylum in different societies; it is a data-rich formulation from a psychosocial and political perspective. What is missing for practising psychiatrists, however, is a review of changing psychopathology and diagnostic formulation. While there are numerous case studies, the emphasis is on the large psychosocial and political engines that shaped the asylum’s development. Only 1 of the 17 contributors has formal psychiatric training: the rest are social historians, some of whom (such as David Wright) have a special interest in the historical epidemiology of mental illness.

The opening chapter on the history of the South African asylum at Robin Island is illustrative of later chapters. In it, the author emphasizes that the initial function of this asylum was to house an overflow of black prison inmates. Over time, “the proportion of white patients rose as the asylum underwent reforms along moral management lines.” By the early 20th century, the original forensic black population was restored as the white middle-class inmates were channelled to new asylums. The remaining black inmates, who represented “the most dangerous and threatening members of society,” were both excluded from society and contained.

The Canadian audience will be interested in the chapter on the Toronto, Hamilton, and London asylums. The inmate population reflects a more democratic selection of patients admitted across the adult age spectrum and representing the general population. The population also reflects the wider sociopolitical issues of employment patterns, kinship networks, immigration, and socioeconomic growth in Victorian Ontario. This readable chapter, by David Wright and his colleagues, explodes the myth that women were overrepresented within these institutions. The close proximity and reintegration of patients into their local family environment wherever possible portrays a kinder, more informed aspect of the early Canadian asylum. Reference is made to the book’s ongoing theme—the still-pressing need to place those who suffer from mental illness more appropriately in institutions other than jails. In Victorian Ontario, this issue was politicized, and the development of asylums was fuelled in part by the political orientation of the local judiciary. As noted earlier, detailed analysis of psychiatric symptomotology has yet to be undertaken: for all the work that has been conducted around the world on the socio-demographic characteristics of patients, there has been little attention paid to the symptom profile of these patients (p 127)

Later chapters on the records from asylums in Berlin and South Carolina emphasize the impact of war and local political climates on the patient population and the negative impact of a deteriorating socioeconomic climate on the smooth running of the institutions: deteriorating financial circumstances, overcrowding, and marginalization of basic custodial care. Chapters discussing Mexican asylums and limitations in the development of sex-segregated national hospitals in Argentina reflect the class struggles in both countries, where economic forces hindered the political will for reform of asylums. A chapter on Nigerian asylums examines the influence of the move to independence and the subsequent benign neglect of British psychiatry.

Throughout the book, the authors illustrate the “drive to confine the insane and to consolidate the procedures of incarceration” (p 16). Power struggles pitting doctors against higher-level political administrators whose decisions influence public policy are illustrated. The community’s need to provide “street sweeping” committal implemented primarily by the police is contraasted with the family’s desire to get difficult relatives out of the domestic sphere. Worldwide, we see a very different psychiatry for the poor, compared with the rich. The book advances the thesis that medicine and, by implication, psychiatry can be seen as intrinsically colonial pursuits “colonizing” the body and the patient. The “psychiatric enterprise never achieved the ambiguous respect of politicians, the press pundits or the people” (p 18). The book argues that asylums should not be a weapon controlled by the psychiatric profession or the state but “a contested site” subject to continual negotiation among different parties, including families and patients themselves. Monolithic and conspiratorial accounts are replaced by accounts that emphasize the role of consumers (purchasers) as well as suppliers within a market model.

This is a book for social historians of medicine and psychiatry. It will also inform students and, hopefully, the administrators of our institutions. Although not brief, the book is clearly written and offers many charts and tables to satisfy scholars searching for data related to the historical epidemiology of mental illness. The book gives the lie to the simplistic idea that one can understand the problem of asylums and mental illness simply in terms of a contrast between the psychiatric profession’s role in developing a place for care and cure and “a convenient place for locking inconvenient people” (p 4). The book achieves a balance between bottom-up and top-down histories that reflects the many different power bases existing in this complicated and evolving story.

Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé