Canada owes much to its Irish-born physicians, and one of pre-eminence was Joseph Workman. Joseph, born near Lisburn, County Antrim, one of a family of ten, immigrated to Montreal with his parents in 1829. He entered McGill the following year and graduated from its medical school in 1835. His thesis explored cholera, a disease new to the world, that had seriously ravaged Canada in both 1832 and 1834. His thesis also demonstrated an independent mind, for the young Workman, in believing that cholera was contagious, differed from most of his profession.
 

Joseph Workman, viewed here circa 1849, was the compassionate superintendent of Toronto’s Provincial Lunatic Asylum between 1853 and 1875. [Photo, courtesy Metropolitan Toronto Reference Library/T-10261]

He married a Montreal woman and practised there for a year, but his destiny awaited in Toronto. By 1836 he had become a full-time partner in his in-laws’ hardware business and was a highly successful Toronto merchant. Other energies were channelled into local politics—for example, as alderman for St. David’s Ward— and into the writing of biting, inflammatory prose in support of Upper Canada’s Reform politics. He also became the first chairman of the Toronto School Board and strongly espoused the then controversial causes of free (i.e. tax-supported) and universal public school education.

In 1846, after John Rolph succeeded in inducing the middle-aged Workman to join the faculty of the medical school Rolph had founded in Toronto in 1832, Workman returned to medical practice. It says something for the casual nature of medical education that a man whose medical education had consisted of a year or so of practice in another city and whose chief concern for many years had been sales of hardware should have been sought out by Rolph as a teacher, first of midwifery and later of materia medica.

In the mid-nineteenth century, in efforts to house and treat the insane, politics were pre-eminently and directly involved. When Dr. John Scott, the fourth superintendent of the Toronto Asylum at 999 Queen Street, resigned, the Premier of Ontario had a candidate in mind for the post, a man with no psychiatric knowledge. Dr. John Rolph, a politician in 1853, also had a candidate with no psychiatric expertise. Whether Rolph somehow knew that his candidate would be successful or whether he was simply fighting another political battle at the pork barrel is unknown, but Workman got the job.

Fundamental to grasping and understanding Workman’s position in Canada’s history is seeing how the insane previously had been treated. In the absence of asylums, public or private, those who had any kind of mental difficulties serious enough to be publicly visible were often badly treated. Families tried to hide their shame by tying up the patient or by locking him or her in a closet or shed. When the “lunatic” became too loud or too violent, then appeal might be made to the local jail to take in the unfortunate.
 

Superintendent of Ontario’s Provincial Lunatic Asylum from 1853-1875, Joseph Workman (1805-1894), in his annual report to the provincial legislature of 1859, decried the underfunctioning of the province’s mental health care system, claiming that “denying to the insane the benefits of early treatment is very erroneous public economy.” Vigorously promoting public awareness of the plight of “lunatics,” the legacy of Workman is that his mandate became a universal norm. [Photo, courtesy Museum of Mental Health Services (Toronto) Inc.]

By the 1830s, a definite change was necessary. The number of “lunatics” was increasing. Legislation was needed as well as a different approach to the problem. Dr. Charles Duncombe issued a report in 1836 pointing to the high cure rates of some European institutions. The rates he cited were never achieved in Ontario or perhaps anywhere else, but the public was impressed by his vision and the government committed funds to build a provincial asylum in Toronto. It was perhaps just as well for Duncombe that he fled the country in the wake of the 1837 Rebellion in which he was a principal figure and thus never had to justify his optimistic predictions.

The Provincial Lunatic Asylum, as it was called, was not completed until 1850 and even then the work was inadequate. When Workman took over the Toronto Institution in 1853, among other messes he inherited was a basement full of sewage. Three years earlier, no arrangements had been made for the outflow.

But the real problems existed not so much in the basement as in the wards. Neither the physical nor the mental health of the patients had been attended to adequately. Daily meals were improved. Medications were decreased in amount, a salutary move since many of these were probably harmful. Instead of pills and potions, Workman prescribed alcohol. In one year the expenditure on wine, beer, and spirits was ten times that for medicines. The patients improved physically.

Workman was, of course, especially concerned about the mental condition of his charges. Over the previous half century, dating back at least to Philippe Pinel’s memorable casting off of the chains confining the patients at his Paris hospital, an approach to madness had been worked out called “moral treatment.” Kindness was the revolutionary ingredient along with encouragement of exercise and work rather than mandatory idleness within locked cells and wards. By the mid-nineteenth century, a few asylums doors were being unlocked.

The anticipated dramatic cures did not occur. Unquestionably, many patients did much better under the new regime, but Workman and his colleagues had optimistically expected a massive clearing out of the hospitals. Nothing of this sort occurred. Yet the basic premise was sound: mentally disturbed patients do better when they are treated with kindness than when they are ill-used. That the revolutionary Workman and his fellow asylum superintendents could go no further is no criticism of them. Even late in the twentieth century, cure of many mental disorders remains elusive.

Workman, as always with those in his position, continually requested more funds from government. The government of his time, like others, responded, not with more money, but with more control. It established a centralized system intended to cut costs, not increase them. And while the government did, over the next two decades, build additional asylums, increasingly the bureaucracy exerted tighter controls.

One of Workman’s most important characteristics, given that he worked much of his adult life in the political arena, was his ability to fight the system and deflect, if not defeat, the politicians. Fearlessly he pointed out the stupidities that seemed inherent in a medical system controlled by politicians. Ultimately the system won and, in 1875, Workman resigned his position. He was then 70 years old with a distinguished and respected international reputation.

He had written much while becoming a pioneer in the field now known as psychiatry. His titles included Asylum Management, Crime and Insanity, and Demonomania and Witchcraft as well as the mandatory stream of official annual reports. He was a skilled linguist and translator: Canadian journals often carried his translations of Italian or Spanish medical papers.

Workman achieved widespread recognition among his peers, as evidenced by his presidencies of the Toronto Medical Society (later the Academy of Medicine of Toronto), the Ontario Medical Association, and the Canadian Medical Association, yet he remained a man of modesty with a low level of personal vanity. Late in his life, a group of colleagues commissioned a bust of the man at their expense. Workman put up with the necessity of spending several hours as the artist’s model but afterwards concluded: “I would not sit again for all the busters in Canada.”

Today as well as then, Workman’s fundamental importance is his establishment of the role of asylum superintendent as an honourable one, with the consequence that the plight of the inmates began to be taken more seriously. Although the results of his moral therapy disappointed him, the approach was a fundamentally sound one. Though this policy did not originate with Workman, he promoted it vigorously, and it became a universal norm. He did much to humanize not only the treatment of “lunatics” but also their perception by the general public. These were real attainments deserving recognition.

Charles Roland