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CLARKE, CHARLES KIRK, psychiatrist, asylum superintendent, educator, and hospital administrator; b. 16 Feb. 1857 in Elora, Upper Canada, son of Charles Clarke* and Emma Kent; m. first 20 Oct. 1880 Margaret DeVeber Andrews (d. 1902) in Parkdale (Toronto), and they had four sons and two daughters; m. secondly 20 July 1904 Theresa Gallagher in Kingston, Ont.; d. 20 Jan. 1924 in Toronto.

After graduating from high school in Elora, Charles K. Clarke began work in 1874 as a clinical assistant at the provincially run Asylum for the Insane in Toronto. His hiring was largely due to the fact that two of his sisters had married psychiatrists, one a son of the asylum’s superintendent, Joseph Workman*. Clarke received his medical degrees from the University of Toronto (mb 1878, md 1879), and in 1880 he was appointed assistant medical superintendent of the Hamilton asylum, where he found the staff an “uncontrollable rabble.” In 1882-85 he occupied the same position at the Rockwood Asylum in Portsmouth (Kingston). Upset by asylum politics, he decided to resign but when Rockwood’s medical superintendent, Clarke’s brother-in-law William George Metcalf*, was killed by a patient in 1885, Clarke was promoted superintendent. He accepted, he later said, “to protect several hundred defenseless creatures from a political hireling who might be pitchforked into the position.”

At Rockwood, Clarke introduced an infirmary for acute cases, occupational therapy, and a psychiatric training program for nurses, the first in Canada. In 1895 he was named professor of mental diseases at nearby Queen’s College, which would confer an lld on him in 1906. In 1904 he became co-editor of the American Journal of Insanity (Baltimore). The next year he succeeded Daniel Clark* as head of the Toronto asylum, a position he would hold until 1911, when he became medical superintendent of the Toronto General Hospital. A founder and vice-president in 1907 of the Canadian Hospital Association, a year later he assumed the posts of psychiatrist at the TGH and, at the university, professor of psychiatry and dean of the faculty of medicine. He stepped down from the superintendence of the hospital in 1917, becoming its medical director, and left it altogether the following year when he was made medical director of the Canadian National Committee for Mental Hygiene. Two years later he resigned as dean to devote his full energy to this committee.

Despite Clarke’s dedication to psychiatry, his personal interests were diverse. At age 15 he had lost two middle fingers in a hunting accident, but he still became quite adept with his hands, building boats, a house, and a pipe organ, among other projects. He was an avid tennis player – in 1890 he and Dr William Gage won the Canadian doubles championship. In later years he took up golf and played the violin in the Toronto Symphony Orchestra. Associates remembered him as a “mirthful conversationalist.” A serious naturalist and ornithologist, he had a summer home in eastern Ontario.

Clarke’s professional career can be broken into two stages. The first, until 1911, was accented by his service in the asylum system, where, for most of the 19th century, psychiatry was based. The physicians of Workman’s generation believed there was little they could do for patients other than shelter them, hoping their symptoms would remit. But by the turn of the century, more and more psychiatrists, dissatisfied with practice in asylums, began looking outside for ways of preventing and treating mental illness. The upshot was a growing interest in outpatient psychiatry, child-guidance clinics, Freudian psychoanalysis, scientific research into the biological conditions of mental disease, and such eugenic policies as sterilization and restrictions on marriage and immigration. Essentially conservative, Clarke did not subscribe to some of these new directions – including Freudianism and “sex problems ad nauseam” – but quite often he was in the forefront of innovative thinking.

During the asylum phase of his career Clarke worked constantly to improve the conditions of patients. Possessed of an authentic fondness for the mentally ill, he abhorred the stigma they traditionally bore. Following the lead of Metcalf, Richard Maurice Bucke*, and others, at Rockwood he had rebelled against traditional techniques, easing restraints on patients and attempting to treat them humanely. He tried assiduously to destroy any resemblance between an asylum and a prison, and would eventually succeed in reducing the stigmatic designation by having Ontario’s asylums renamed hospitals for the insane. But while he rejected many past policies he did not strictly oppose gynaecological surgery on patients to cure disorders; he did, however, object to the appeal made by R. M. Bucke and Alfred Thomas Hobbs of the London asylum to the National Council of Women of Canada to gain wider support for this type of treatment. A frequent expert witness at trials, he argued that some criminals were actually insane and not responsible for their actions. For instance, though he had not examined Métis leader Louis Riel*, he later diagnosed him as an “insane paranoiac” who should not have been hanged.

By the 1890s Clarke’s enthusiasms had begun to wane. His persistent requests of the government, for more resources and policies for better care, had fallen on deaf ears. Physically strong, he had survived a number of attacks by patients, but too many incurable and violent cases appeared to be entering his wards. His interests, in fact, were shifting to preventive psychiatry or, as it was called, mental hygiene. A steady source of professional articles in journals, he longed to found an institute where, unlike in an asylum with its never-ending administrative demands, he would have time to examine patients thoroughly and oversee the scientific study of mental diseases. Undoubtedly Clarke would have excelled in such an environment – few physicians had a keener clinical eye when it came to distinguishing one psychiatric condition from another. His model was the clinic in Munich of pioneering German psychiatrist Emil Kraepelin.

When Clarke accepted the Toronto job in 1905 he hoped his dream could be realized. Working closely with provincial secretary William John Hanna*, he researched the project and travelled to Europe with others in 1907 to inspect psychiatric facilities there. Ultimately his plan fell through, though in 1909 he would introduce Kraepelin’s classification of mental diseases. Clarke put some blame for this failure on politicians and professional rivals among hospital neurologists, but he mainly held his colleagues in asylum psychiatry responsible. If his charge is true, it is hard to fault them for complaining: Clarke wanted to monopolize the most interesting and treatable patients, and dispatch the rest to the public asylums.

Clarke’s resignation from the Toronto asylum in 1911 highlighted his transition to the second stage of his career. He now devoted himself to prevention and the treatment of psychiatric outpatients. He had already opened an outpatients’ clinic at the TGH in 1909 under the direction of the brilliant Dr Ernest Jones; it was discontinued in 1913, when Jones left and pending completion of a new hospital complex, but a new Social Service Clinic was opened in the spring of 1914. There Clarke, Clarence Meredith Hincks*, and other psychiatrists diagnosed troubled young men and women sent by Toronto’s schools, courts, and social agencies. Still interested in provincial policy regarding the mentally handicapped, in 1912 Clarke had helped form the Provincial Association for the Care of the Feeble-Minded. At the same time that it argued for better care, he and others castigated the government for its reluctance to segregate “imbeciles” from their families.

During the early years of World War I, much of Clarke’s attention shifted to that conflict. Military service depleted the staff of the TGH, which gradually began filling up with returning servicemen. In 1915, the same year that Clarke established a ground-breaking clinic for venereal diseases, he helped in the organization of No.4 Canadian General Hospital unit, which went overseas, and in 1918 he became consultant in psychiatry to Military District No.2 (Toronto and central Ontario). The following year the federal Department of Soldiers’ Civil Re-establishment selected Clarke and one of its own psychiatrists, Captain Clarence B. Farrar*, to conduct a country-wide examination of asylums, in part to push for greater provincial aid for mentally disturbed veterans. In Ontario the two doctors encountered resistance from the office of provincial secretary William David McPherson, which, mindful of Clarke’s record of criticism, insisted that only provincial inspectors could visit hospitals there. According to Farrar, Ontario held Clarke to be a persona non grata.

During the war years Clarke returned to an issue that had preoccupied him for some time. After 1900, in an extreme demonstration of preventive medicine, he had emerged as one of the most vocal and most publicity-seeking critics of Canadian immigration. The years between the end of the century and the war witnessed an enormous boom of newcomers, from 21,716 in 1897 to 400,870 in 1913. As a result, a growing number of foreign-born patients began appearing in Ontario’s asylums – Clarke saw many more in Toronto than he had at Rockwood. The composition of this influx concerned him. Of the 1,244,597 immigrants who came between 1900 and 1909, 315,151 were from central and eastern Europe. Mostly anecdotal information conveyed the impression that a large percentage suffered from hereditary mental disability. Such impressions drew attention to Canada’s immigration law. Before 1902 virtually no medical inspections were made at the points of entry, and the laws governing deportation were inadequate. Even when inspection was begun there were too few physicians and facilities to handle the flow at the busiest ports. Later amendments to the Immigration Act helped, but the testimony of medical inspectors and public-health officials stressed that too many mentally and physically handicapped immigrants were still entering the country. Clarke agreed, and his inspection in 1901 of the hospital for the insane at New Westminster, B.C., which housed considerable numbers of Chinese-born patients, reinforced his view. In 1905 he stepped up his lobbying for more and better-trained psychiatrists as medical inspectors. In addition, he began publishing articles on the “defective and insane” immigrant. However, in 1907–8, he later recalled, he found himself “in the centre of an unpleasant controversy, as the facts and figures presented did not appeal to practical politicians who were anxious to cultivate the vote of the new immigrant who had recently arrived.” He therefore toned down his campaign, concluding that the time was not ripe for aggressive activism.

In 1916, sensing that changing circumstances had revitalized public opinion, Clarke rejoined the immigration debate. Many Canadians now felt that the best and healthiest young men of Canada were being sacrificed on the battlefields while the unfittest stayed home and begat their own kind. Such concern would lead to heightened fear about the immigration of unfit aliens once the war was over. The Provincial Association for the Care of the Feeble-Minded folded in 1918 when Clarke, Hincks, Helen MacMurchy*, and others founded the Canadian National Committee for Mental Hygiene, initially to attend to the psychiatric care of soldiers. It favoured prevention, including the screening of immigrants, whom it viewed as a primary source of mental degenerates (and therefore also of vice, disease, and unemployment). The growing interest in mental health, thus perceived, persuaded Clarke that the time was right to renew pressure on Ottawa. He drew on the enormous literature in the United States about immigration, much of which was part of the eugenic movement then sweeping North America. (Coined in 1883 in Britain, the term eugenics meant the study of heredity and the production of healthy offspring through the prevention of inherited disease.) A convert like most physicians of his day, Clarke believed that many European nations were trying to get rid of their insane and otherwise “defective” citizens by sending them to Canada or the United States, where, by reproducing their own kind, they posed a national menace.

Clarke used various means to alert public and official opinion to the eugenic dimensions of immigration. The receptive Public Health Journal (Toronto) published his denunciation in 1916 of the “defective immigrant” and in 1918 his theory on feeble-mindedness as the foundation of criminality. Among mps he circulated copies of his unpublished novel, “The amiable morons,” a thinly disguised account of Valentine Shortis*, the Irish immigrant who in 1895 had killed two men and wounded a third with no apparent emotion or motive. Clarke had testified at Shortis’s trial that he was a hereditary degenerate who had been insane at the time of the murders. Avoided by publishers, the manuscript emphasized the link between immigration and hereditary illness.

As a result of the efforts of Clarke and the CNCMH, in 1919 parliament approved amendments to the Immigration Act, but Clarke remained dissatisfied. Medical inspectors continued to serve merely in advisory roles, filling out forms and relying on civil officials to decide on admissions. Frequently these officials overlooked entry regulations when ordered to do so by government authorities. For Clarke and many other psychiatrists, the system would remain inefficient until inspectors were posted abroad, at the ports of embarkation, a reform that would not materialize until 1928.

After 1919 Clarke continued to find an audience. From his Toronto clinic he drew statistical findings about immigrants that are now seen as dubious and unrepresentative, but which were then readily received in many quarters. His often sensationalized linkage of feeble-mindedness, immigration, and national degeneration fed into the premises of such moral reformers as Charlotte Elizabeth Hazeltyne Whitton*, who were glad to have “scientific” endorsement of extreme, even nativist, immigration policies. In 1920 a meeting of the Presbyterian Church’s Canadian Council for the Immigration of Women proved very receptive to Clarke’s constructs and his proposals to weed out Jewish children fleeing famine in Ukraine. On another occasion that year, the arrival at Saint John of the first contingent of Barnardo orphans to come to Canada since the war, Clarke staged a public demonstration to reinforce his preferences and arguments. Though the children had been carefully examined in England, Clarke and “an array of medical experts” nonetheless put them through “thorough tests – followed by congratulations on the high-grade type of children.”

Clarke’s crusade helps explain how, in delivering the prestigious Maudsley Lecture before the Royal Medico-Psychological Association in England on 24 May 1923, he could announce that immigration had pushed Canada to the brink of crisis. It was being “bled white” by emigration to the United States and pumped full of defectives, many of them British. The lecture underscored the fact that the issue exerted a powerful, almost mesmeric attraction on his mind. He campaigned so relentlessly that he alienated numerous provincial and federal authorities. On occasion acerbic, combative, and stubborn, he was rarely diplomatic when it came to immigration and other concerns that he felt strongly about. Such force was necessary to sway minds on what, in his opinion, were vital public-health questions. By the late 1920s, however, the psychiatric profession was beginning to move away from the crude eugenics advocated by Clarke and the CNCMH.

Though Clarke’s professional life was largely taken up with CNCMH activities after 1918, other involvements contributed to his high profile. His controversial campaign for a true psychiatric clinic bore fruit in 1921, when a site was secured on Surrey Place near the TGH and the university; in 1923 Clarke was present at the laying of the cornerstone for the Toronto Psychiatric Hospital. Commissioned that year to assess Homewood Retreat, a private asylum near Guelph, he scored the sharp decline in its facilities for the acutely insane and the human costs of a greater resort to chemical and mechanical restraint. During the 1920s two of his children were also active in the field: Eric Kent was a psychiatrist in Toronto’s health department, while Emma DeVeber, who had served overseas as a nurse and at the TGH clinic, was supervisor of mental hygiene nursing with the city. An Anglican – his second wife was a lifelong Roman Catholic – C. K. Clarke died of cardiovascular disease in 1924 and was buried in Mount Pleasant Cemetery. The Clarke Institute of Psychiatry in Toronto, which was named in his honour in 1966, merged into the Centre for Addiction and Mental Health in 1998.

If Clarke’s commitment to public-health reform went as far as punitive eugenic policies, it was less a comment on him than it was a reflection of the times. His bending of clinical findings for eugenic purposes had resulted in part from the inexactitude of diagnosing feeble-mindedness. But in clinical situations where the symptom-pictures were more precisely defined, as in the diagnosis of dementia praecox (schizophrenia), he was on surer ground. That he possessed much purer psychiatric knowledge and ability is affirmed by his scientific publications and professionally significant advancement of Kraepelin’s classification. He had played a seminal role too in many of the momentous changes that had occurred in the field, especially in the break from asylums. Clarke served as mentor for some of the luminaries of the next generation of Canadian psychiatrists, including the internationally renowned Hincks and Farrar, who regarded Clarke as “the father of Canadian psychiatry.”

Ian Dowbiggin