Medicine and Power

Module Artefacts

  • Historical documents, contemporary audio commentaries and a timeline illuminating the history of sterilization in Canada
  • Art and poetry by an Indigenous creator and a context text explaining the link between colonialism, the Indian Act, and the messages expressed in this work
  • A 5-minute puppet show on the importance of healing systems which treat the whole person
  • An autobiographical sculpture of the Psychiatric Gaze, expressing a wish for healing partnerships
  • A 6-minute video depicting Question Man, the ultra ego of patient struggling for a sense of self
  • Links to three After the Asylum research exhibits with more Medicine and Power materials

Module Takeaways

  • Appreciate systemic power imbalances in the mental health system between those who provide and those who use services
  • Understand that human rights are fundamental to ethical and compassionate care
  • Recognize the value of treating the whole person, and the critical importance of incorporating lived experience, history, and culture in creating respectful equitable patient-practitioner partnerships

Module Assessment

Using module artefacts as a starting point, ask students to write a 250-word letter as a compassionate practitioner of today. Student letters should explain how power imbalances in the mental health system can lead to errors in practice, and then propose an alternative scenario that treats the whole person and exemplifies a respectful and equitable patient-practitioner partnership.  Ask students to address their letter to one of the following people featured in the module:

  • Doreen Befus
  • Ya’Ya Heit
  • Lori E.
  • Alistair Scott-Turner
  • Dana Allan
  • Irit Shimrat

Module Learning Lens

Question: What’s the difference between a Doctor and God?
Answer: God doesn’t wake up in the morning thinking he’s a Doctor.

These kinds of (not entirely funny) jokes point to a generalized and ambient understanding that physicians – including mental health practitioners – hold a tremendous amount of power compared to the patients whom they serve. Historically and today, laws, professional structures and political decisions have reinforced practitioner power, even though the radical shift from institutional to community mental health meant that the sites where power was exercised evolved and new professional players came on board. We included materials in this module on the history of state-sanctioned sterilization, legal in Alberta until the 1970s, as a compelling case study of the abuse of professional and state power in the pursuit of alleged good mental health.

The Doreen Befus Story: The Law and Practice of Sterilization

Takeaways: 

  • Recognize the historical role of medicine, science and the law and their institutions in violating the human rights of mental health patients
  • Understand the danger of unchecked professional power and authority as evidenced in the theory and practices of eugenics
  • Appreciate the possible consequences of professional practice that negates individual autonomy and agency
  • Grasp the importance of seeing beyond diagnostic labels

Learning Lens: 

This unit weaves together two connected storylines – the first of eugenics victim and disability activist Doreen Befus and the second of Alberta’s sterilization program, in place from the 1920s to the 1970s. A powerful and provocative set of artefacts direct future mental health practitioners backwards through history to examine how medicine, science, and the law were utilized in particularly unjust ways in the service of “good” mental health. Students will learn how sexual sterilization law came to be seen as positive mental health policy to prevent “undesirable” children and “unfit” parents. Befus demonstrates the resilience and personal courage that is necessary to overcome a stigmatized medical diagnosis and medical label. It is through working with this kind of patient-centred material, and developing a capacity for respectful listening and ability to see beyond the limitations of labels, that the patient-practitioner partnerships that our community experts envision as an optimal practice model will emerge.

Artefacts in Context: 

Sir Francis Galton, an Englishman and cousin of Charles Darwin, created the pseudo-science of eugenics in the 1880s, a school of thought that regarded the human race as a vast breeding stock. For eugenicists, reproduction and the fate of the nation were inextricably entwined, for eugenicist theory categorised an individual as either “superior” and a worthy citizen, or “unfit” and a liability to the nation. The ranks of the unfit included many labelled “feeble-minded” – often a designation shaped by class, race and moral judgement – and sterilization was considered necessary to cull such people from the national breeding stock. As the Sterilization Timeline shows, professional and societal support for eugenics programs was a global phenomena: in 1933, for example, both the Liberal government in British Columbia, Canada, and the Nazi Party in Germany passed sterilization legislation.

Evaluating the Artefacts:

Sterilization as Law and Practice: Self-Guided Learning

Timing: 
45 minutes

Sterilization legislation in Alberta was a legal response to broadly-held eugenicist ideas which understood the larger social good to be dependant on limiting the reproductive capacity of certain citizens. This set of historical documents and audio commentary allows students to unravel the reasoning behind the 1928 Sexual Sterilization Law of Alberta as well as its later amendments. Students analyze historical documents (a Superintendent’s report that attempts to justify this kind of legislation as well as the legislation itself) and hear University of Lethbridge Sociologist Claudia Malacrida explain the history of eugenics and outline key developments to eugenic thought and law in Alberta.

But laws are not just legal acts, they shape our lives, and unjust laws impinge particularly on the circumstances of marginalized and vulnerable people. So social historians, cultural historians and sociologists are interested not only in laws, but also in uncovering and explaining how power operated “on the ground.” In Alberta, a Eugenics Board determined the sexual and reproductive fate of those who were brought before it. But how did the Eugenics Board actually operate? What did it do and how did it carry out its work?

The text and audio commentaries and primary historical documents in this unit allow students to investigate the ideas behind Alberta’s sterilization legislation. Students can work through this material online or in class. These self-guided resources are well suited for flipped classroom use with an in class or online discussion or learning activity.

Ask students to use the following questions to guide their exploration of artefacts for this learning activity:

  • What do these artefacts tell us about the historical role of medicine, science and the law and their institutions in violating the human rights of mental health patients?
  • What is the danger of unchecked professional power and authority as evidenced in the theory and practices of Eugenics?
  • What are the possible consequences of professional practice that negates individual autonomy and agency?

Listen to University of Lethbridge sociologist Claudia Malacrida explain the history of eugenics and outline developments in Alberta.

6 minutes

Read the 1926 Provincial Training School Superintendent’s Report which describes his reasons for being in favour of “selective eugenical sterilization”.

Read the original Sterilization Act of 1928, to compare how it relates to the 1926 Provincial Training School Superintendent’s report above.

After the Second World War, many Canadians were revolted by the eugenic program they learned had been carried out in Germany under the Nazis. Yet provincial sexual sterilization laws in Canada remained on the books until the 1970s.

Listen to Claudia Malacrida explain some of the reasons why the sexual sterilization laws were not repealed earlier.

6 minutes

Read excerpts from the 1938 and 1941 reports:

Listen to Claudia Malacrida explain what the routine yearly sterilization reports reveal about the everyday violence that was inflicted on individuals.

4 minutes

The 1968 Eugenics Board Annual Report has many of the “simple numbers” that Claudia Malacrida mentions. It contains statistics, dates of meetings, numbers of operations performed, and tabular summaries. Read an excerpt from the 1968 Annual Report and consider what it does tell us and what it cannot tell us about how the sterilization laws affected individuals.

But bureaucratic reports usually do not reveal very much about individual experience.

Listen to Claudia Malacrida explain how the sterilization law worked, and describe the format of a Eugenics’ board hearing.

6 minutes

Doreen Befus' Story: Self-Guided Learning

Timing: 
30 minutes

It is very difficult to uncover the voices and perspectives of the targets of eugenics legislation, but this set of resources shifts the focus from the political to the personal. A selection of the letters and photographs that Doreen Befus donated to the Red Deer and District Archives are also included here with audio commentary by Claudia Malacrida and Erika Dyck, allowing students the rare opportunity of appreciating the motivations and experiences of one victim of eugenicist policy.

Doreen Befus debout dans la salle commune de l'établissement

Doreen Befus, Provincial Training School, Alberta, circa 1960s

Doreen Befus’ life also intersected with the history of deinstitutionalization. In the 1960s and 1970s, new notions of the value community living, coupled with legal and financial pressures, resulted in a period of massive deinstitutionalization across Canada. Many psychiatric hospitals and institutions like the Mitchener Centre closed down, the number of available beds was reduced, and many former patients and inmates of such institutions were released into their communities. Befus moved to community living, then to her own apartment, emerging as an advocate and an activist.

Befus’ story makes crystal clear the utter inadequacy of medical labels. Doreen Befus was a caregiver, an activist, a writer, a friend, a sister and an aunt. The medical label of “moron,” however, overshadowed these more important designations for most of her life.

Students can work through this material online or in class. These self-guided resources are well suited for flipped classroom use with an in class or online discussion or learning activity.

Ask students to use the following questions to guide their exploration of these artefacts:

  • What are the possible consequences of professional practice that negates individual autonomy and agency?
  • What does Befus’ story tell us about the importance of seeing beyond diagnostic labels?
  • How did the victims of these laws and procedures understand their experience, and how did the institutional context in which most of these operations took place shape patients’ understandings of the procedures?
  • How did Befus and other sterilization victims come to terms with their new reproductive limitations?

Listen to Claudia Malacrida describe what she uncovered from her interviews of people who lived in Michener Centre (formerly the Provincial Training School).

5 minutes

Erika Dyck has studied and written about Doreen Befus as a very interesting case study on the topic of sterilization, eugenics, deinstitutionalization and activism.

Listen to Erika Dyck give some biographical context to Doreen Befus’ story.

2 minutes
Doreen Befus tenant un jeune enfant

Doreen and unknown child, circa 1950s or early 1960s

In 1976, as part of the broader shift away from institutional living, Befus moved out of Deerhome institution, and into the community of Red Deer. But Befus’ story reveals how many people like her were unprepared for such independence.

Listen to Erika Dyck explain how Doreen Befus’ history of institutionalization affected her life and activism outside of the institution.

5 minutes

Befus’ experiences of institutionalization, deinstitutionalization and sterilization helped to shape the kind of activism she engaged in once she was living on her own. Explore some of the letters she wrote on the subject of institutions. In Befus’ 1980 letter to the Alberta Association for the Mentally Retarded she explains her perspective on institutions for “mentally handicapped” individuals.

In Befus’ 1980 letter to Phoenix Rising Magazine she expresses her concern over the “unfair” conditions in institutions like Michener Centre and her frustrations regarding the apparent lack of government interest in, and the clear lack of funding for, these institutions.

Despite all the records that Befus kept (and later donated to the Red Deer Archives) we know very little about her thoughts on sterilization. One letter, written by Befus to Leilani Muir’s lawyer, provides us with some clues, however. Leilani Muir successfully sued the Alberta government for wrongful sterilization in 1995. Her particular kind of activism, shaped by her experience of institutionalization and deinstitutionalization, also seems to have given shape to her opinions on sterilization. Befus expresses some of these opinions in this 1993 letter to lawyer Sandra Anderson.

Listen to Erika Dyck’s interpretation of Befus’ response to lawyer Sandra Anderson and her stance on the sterilization lawsuits that were emerging in the 1990s.

5 minutes

How can we interpret Befus’ stance on sterilization?

Listen to Erika Dyck comment on how Doreen Befus’ life story helps us to understand her acceptance of her reproductive fate.

4 minutes

A Sterilization Timeline: Contextualizing the History of Sterilization

Timing: 
30 minutes

Context is important in appreciating historical events, ideas and practices. The history of sterilization and eugenics in Alberta, and the story of Doreen Befus' life, needs to be appreciated as part of a much larger national and international project, linked to mental health treatments and programs. This historical timeline integrates Doreen’s story with the history of eugenics and mental health in other parts of Canada and the western world, providing learners with a wider viewpoint for understanding and appreciating this difficult history. 

The story of Doreen Befus, sterilized as a teenager without her knowledge or consent, makes the potential extremes of unfettered medical power real for students. This artefact can be used by instructors who have a limited amount of time to devote to the topic of sterilization, or as the basis for a culminating learning activity on the subject. This activity can be completed online or in class. 

Instructors using this as their only activity on the history of sterilization can assign some or all of the following sections from this unit to give context: Learning Lens, Sterilization as Law and Practice, Sterilization Timeline, and Doreen Befus’ Story.  Instead of standard note-taking, have students “map” annotations onto the timeline, adding the thoughts and responses of Befus, other victims/activists’, law-makers and medical staff to dates and items listed on the timeline.

Instructors using this as a culminating learning activity can encourage students to add information that they have learned from reviewing documents and listening to audio clips. This can be done as an individual or group assignment and online or in-class. Instructors may also wish to assign specific decades of the Timeline or roles (i.e. victim/activist, law-maker, medical staff) to individual students or groups of students. Timing for this activity is based on it being used as a culminating learning activity.

Learning Activity Type: 

Ya'Ya Heit: An Indigenous Perspective on Medicine and Power

Takeaways: 

  • Recognize colonialism as a distal determinant of mental health and wellbeing and the relevance of the Indian Act to mental health and wellbeing of Indigenous peoples
  • Understand the impact of historical and legal forces on current material circumstances and mental health and wellbeing of Indigenous peoples
  • Appreciate Indigenous experiences and understandings of mental health and wellbeing

Learning Lens: 

Photo of Ya'Ya Heit standing beside carved wooden sculpture with Indigenous west coast mythical representations of animals.

Ya'Ya Heit with his 2003 sculpture "Who The Hell Wants These Chains"

When compared to non-Indigenous settler Canadians, Indigenous peoples (as a population) live with significantly higher rates of poor-health. They die younger, live with higher rates of diseases and greater rates of poverty, experience more discrimination and social marginalization/exclusion, and have less education and employment. This means, very practically, that if you are an Indigenous person living with a mental health illness, you are likely also living a life, as compared with a non-Indigenous counterpart with similar mental health realities, that is more challenging, more marginalized.

Artefacts in Context: 

Ya’Ya Heit was born into the house of Geel, the leading Fireweed clan house in Kispiox. His Gitxsan name is Axgagoodiit and he has noted in interviews that politics and justice are a major influence on his work. Ya’Ya Heit’s work has appeared around the world and, most recently, he is at work carving two panels for Osgood Hall in Toronto.  A member of the Health Arts Research Centre’s (HARC) Advisory Committee in Northern BC, Ya’Ya Heit’s longer biography is available on their website.

Evaluating the Artefacts:

Ya'Ya Heit, Mental Health and Indigenous Colonialism: Self-Guided Learning

Timing: 
10 minutes

Ya’Ya Heit makes a very clear connection between Indigenous experiences of mental health and wellbeing and the historical and contemporary context of colonialism. Begin by having your students read the Learning Lens and Artefacts in Context sections from this unit as background and examine Heit’s art and read his poetry. Done online or in class, this work can be a preparation for the Visualizing Colonialism activity or a written or spoken reflection or a discussion on Ya’Ya Heit’s art and writing. Have students use the following question as a guide:

  • What do these pieces of art reveal about the link between colonialism, mental health, and wellbeing for Indigenous peoples?

Visualizing Colonialism

Timing: 
30 minutes

Ask your students to research the concept of distal determinants of health (see for example all or portions of Health Inequalities and Social Determinants of Aboriginal Peoples' Health). Assign your students to small groups and provide each group with appropriate online or in-class tools for this exercise. Ask each group to develop a mind map, visually displaying their understanding of how colonialism directly relates to Indigenous experiences of mental health and wellbeing. Encourage your students to begin by incorporating the information they learned from Ya’Ya Heit and the Learning Lens and Artefacts in Context sections of this unit before moving on to outside materials.

Learning Activity Type: 

MoVay's Way

Takeaways: 

  • Appreciate the importance of service user perspectives in determining appropriate plans for care and wellbeing
  • Recognize the importance of exercise, food, and sociability in supporting good mental health and caring for the whole person

Learning Lens: 

What if you were diagnosed with Chronic Blue-Sologizing? This 3-minute video of a project puppet-show asks us to consider treatment alternatives beyond medicine, and suggests that holistic treatment through nutrition, social support, and physical exercise supports good mental health. An additional artefact, to be used if time allows, is an artist statement by puppeteer and community expert Lori E.

Evaluating the Artefacts:

"Moy-Vay's Way" uses puppetry to present a holistic perspective on living with mental health difficulties

 

MoVay's Way: Responding and Working Through

Timing: 
15 minutes

MoVay’s Way allows students to engage with complex ideas in an open and innovative way. Students can begin by watching the puppet-show. Free writing, in response to the puppet show, is a good way to motivate your students to think outside of the box. Also, allowing your students the flexibility of writing from free flowing thoughts can remove any worry or anxiety that students may struggle with when writing. At the end of the free write, have your students underline their favourite sentence and invite them to share it with the rest of the class. At this point students can also respond to the artist’s statement. This exercise can be done in-class or online.

Learning Activity Type: 

MoVay's Way: Mobile as Metaphor

Timing: 
15 minutes

MoVay’s Way is an art intervention, a nuanced call for broader approaches to wellbeing which value the spiritual, the social, and the physical. MoVay’s creator is focusing on the importance of balance, and this learning activity invites students to consider the role of balance in promoting wellbeing. Using Lori E.’s Artist’s Statement and puppet show as reference points, ask students to create a mobile. (A mobile is a work of art hung from above with individually attached shapes or figures. Balancing the weight and placement of the separate attachments is key to mobile construction.)

Artist's Statement, by the creator of "Mo-Vay's Way"

3 minutes
Learning Activity Type: 

The Psychiatric Gaze

Takeaways: 

  • Appreciate the negative impact of power imbalances and distance in the mental health system between those who provide and those who use services
  • Understand the damage that can be done in the practitioner-patient relationship when patients are understood through their diagnoses rather than their skills and life experience
  • Recognize the potential of an egalitarian patient-practitioner relationship

Learning Lens: 

All of our community partners described oppressive experiences accessing mental health services. Creator Alistair Scott-Turner, is a psychiatric patient with a host of diagnoses ranging from “angst” to schizo-affective disorder and many, many things between. Co-creator Dana Allan has a long standing eating disorder with body dysmorphia, anxiety and depression. In her words “Just your basic crazy anorexic.” As community experts on our project, they wanted to make a sculpture that expressed their belief that mental health professionals could not see the whole people that live behind (and in spite of) the diagnostic labels that are placed on them. This makes their sculpture activist art or an art intervention, in reference to art that is placed outside the art world to raise awareness and try to change existing conditions.

Allan and Scott-Turner’s sculpture puts the viewer in the place of a person treated poorly in mental health institutions and says, this could be you. The accompanying artists’ statement explains the ideas behind the sculpture’s creation. Instructors can use these artefacts to explore possible avenues toward egalitarian patient-practitioner relationships.

Evaluating the Artefacts:

The Psychiatric Gaze: Expressing Ideas in Art

Timing: 
15 minutes

An art intervention can be an original piece of art or an interaction with art that has been created by another person. Exploring course content through the production of artistic interventions allows students to process information in a multimodal fashion.

Ask students to look at the Psychiatric Gaze Sculpture and read the accompanying artists’ statement, either online or in class. Then invite them to propose a design for a piece of art that responds to the sculpture and to also suggest a public space where it will be placed. Student designs should be a conceptual/visual representation of an egalitarian patient-practitioner relationship (may include characteristics, values, beliefs, practices). As part of their work students should explain the rationale for their proposed design and its location. This activity can be done in class or online.

Instructors and students may choose to take this assignment one step further and create their planned art intervention.

If this is a graded assessment, then choose the flexible timing option and focus on the students’ ability to explore complex ideas and communicate clear understandings of major module takeaways when marking the artistic intervention.

Learning Activity Type: 

Question Man

Takeaways: 

  • Appreciate that patients may experience mental health services as oppressive and soul destroying
  • Understand the importance of practitioners working with patients to help reclaim strengths and strategies that were part of their identity before they experienced mental health difficulties
  • Value voice, resiliency, resistance and experiential knowledge in supporting good mental health

Learning Lens: 

In the late 1970s Irit Shimrat was an involuntary psychiatrist patient at the Branson Hospital in North York, Ontario, prescribed the anti-psychotic drug Haldol. Medicated and stripped of the capacity to do many basic things which most of us do each day without thinking, Shimrat reclaimed her creative spirit and sense of self by creating Question Man, an alter-ego and a friend. Based on Shimrat’s 1978 ward notebook, this 6-minute video tells the story of Question Man‘s creation, illuminating both the flattened world of the psychiatric patient and the power of personal resiliency. Her story underscores the value of a whole-person approach and reminds us to nurture strengths and coping strategies.

Evaluating the Artefacts:

Question Man: Self-Guided Learning

Timing: 
10 minutes

Irit Shimrat’s short video illuminates both the extreme loss of self that is characteristic of emotional and mental crisis and the potential for personal resiliency in difficult circumstances. Educators and learners can use this artefact to explore patient-practitioner relationships and the potential for different approaches to healing. Students can work through this material online or in class in preparation for a discussion or learning activity.

Ask students to use the following questions to guide their viewing of Question Man:

  • How would you describe the relationship between Irit Shimrat and Question Man? What was the dynamic between the two of them?
  • Shimrat needs to write to find her lost self, but what other strategies might help people move past “lostness” to reclaim self?
  • How can you as a practitioner work with people to assist them to locate knowledges and strategies within themselves?

"Question Man" by project community expert Irit Shimrat

 

Learning Activity Type: 

Question Man: Strength Through Storytelling

Timing: 
20 minutes

Question Man is really Answer Man, and Shimrat’s story is about finding answers and wellbeing within the self. In a poem, spoken word or single-frame cartoon, and using the following questions as guides, have students depict what Question Man’s answer was for Shimrat.

  • How would you describe the relationship between Irit Shimrat and Question Man? What was the dynamic between the two of them?
  • Shimrat needs to write to find her lost self, but what other strategies might help people move past “lostness” to reclaim self?

How can you as a practitioner work with people to assist them to locate knowledges and strategies within themselves?

Learning Activity Type: