The Astley Ainslie, Mabel McRae, and the Canadian Connection

Judith Friedland, PhDProfessor Emerita, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto  

University of Toronto Occupation Therapy class. Mabel McNeill MacRae pictured on bottom row, third from left

In 1933, in the very first issue of the Canadian Journal of Occupational Therapy, Dr. Goldwin Howland, then President of the Canadian Association of Occupational Therapists, proudly reported “…Miss Amy DesBrisay of the Toronto General Hospital staff will commence work in Edinburgh, Scotland at the Astley Ainslie Institution under the direction of Lieutenant-Colonel Cunningham, IMS (Retd.). We hope to see a steady and cordial relationship develop between our Canadian Aides and British Institutions” (Howland, 1933, p.5).

Indeed, a steady and cordial relationship did develop over the years. Amy DesBrisay spent four months at the Astley Ainslie which was apparently long enough to open an occupational therapy department, and then her successor, Mabel McNeill McRae, arrived and it was she who developed the program and designed the occupational therapy workshops. Other Canadian occupational therapists followed; to continue the early work and to start the first school of occupational therapy in Scotland. It was no wonder that Canadian occupational therapists wanted to come to the Astley Ainslie having seen it described in their journal as “one of the most beautiful and best equippedconvalescent homes in the world” (Minty, 1933, p.29).

The request for a Canadian occupational therapist for the Astley Ainslie had come to the Canadian Association of Occupational Therapists (CAOT) from Lieutenant-Colonel John Cunningham, the Medical Superintendent of the Astley Ainslie. He wanted an experienced Canadian occupational therapist to develop a department at that hospital. It is likely that he knew there were courses in occupational therapy at the University of Toronto (U of T).

The U of T had set up first brief training courses for “ward aides” toward the end of the First World War and Amy DesBrisay was among those who attended. Most of the women who took the courses had been tending to the injured soldiers who had returned home but they wanted to be better prepared for their work. Although occupational therapy had been practiced in Canada (and elsewhere) since the 1800s, particularly in psychiatric institutions, the profession did not become established until near the end of war, when countries that had engaged in the conflict were confronted with the return of their injured soldiers. Occupational therapy was directed at helping soldiers prepare for a return to the work they did prior to enlisting or, when that was no longer possible, for a new type of work that they could do. Convalescence was long and it was necessary to (re)build the soldiers’ morale as well as his skills. Occupations, mainly in the form of crafts, were provided to promote the soldiers’ physical and mental health, at the bedside at the start, and as the soldier’s condition improved, off the ward, and eventually in special workshops (Friedland, 2011).

The training courses for occupational therapists came to an end in 1919, but the work with injured soldiers in Canadian hospitals and convalescent homes continued and, gradually, work with civilians began. The need for occupational therapists became accepted and by 1926, a new two-year diploma course was established at the University of Toronto. Mabel McNeill, then age 17 or 18, entered that program in 1928.

Mabel had grown up in Toronto where she attended Havergal College, a private girls’ high school. She knew nothing of the occupational therapy program at the University of Toronto but her mother did, and she urged her daughter to register. Mabel, or “Mabelle” as she called herself at the time, enjoyed the program. When she graduated in 1930, Torontonensis, the yearbook for the graduates, noted that Mabelle had been on the school executive in her first year, and was the social convener in her second year. She listed her interests as basketball, skiing, and children’s work. It was clear by then that she was an active and engaged young woman who was already displaying leadership skills. Indeed, years later, she was honoured by Havergal College with the Old Girls’ Award given to graduates for their Lifetime Achievements.

When Dr. Howland asked Mabel to go to the Astley Ainslie, it was 1933 and she was working at the Toronto East General Hospital, and already married. Her husband, newly graduated from the University of Toronto’s Faculty of Medicine, was completing some further training and agreed to follow when he finished, four months later. The fact that Mabel’s husband agreed to follow her overseas – the opposite of the more typical arrangement where a husband took a job and the wife followed – was certainly unusual for the times. But then Mabel was a somewhat unusual young woman. She had a strong sense of adventure and a boundless enthusiasm for her profession. At the age of 26 she crossed the Atlantic alone and arrived in Edinburgh. When her husband arrived, he found work doing locums and was able to continue studying – but not in Edinburgh. Mabel lived in residence at the Astley Ainslie. The newly-weds were together on weekends only, but it seems to have worked out.

Mabel worked hard and accomplished a great deal in the time she was in Edinburgh. She worked with 40 patients each day, planning the work for each one, preparing the materials that would be needed, and teaching different crafts. She also designed and drew up plans for a new pavilion for occupational therapy workshops. Her design followed the butterfly shape of the other buildings. One wing of the building was to be used as a “quiet” workshop, while the other was for the noisy” workshop. Pottery and clay work were also done on that side and so was metal work. A verandah stretched across the front of the workshops allowing for work to be done outdoors in good weather.

Occupational Therapy Department, May 1936

As the merits of occupational therapy became better known, and Mabel’s workload increased, a second occupational therapist was needed. A notice in CJOT in1935announced that the appointment of a therapist to assistant Mrs. McRae would be made shortly, noting that several Canadian aides had applied for the position. Gloria Langmaid Macdonald, a U of T graduate of the class of 1933 was appointed assistant occupational therapist and joined Mabel in 1935 (Ellis, 1935 p. 29).

Dr. Howland continued to praise the Astley Ainslie in subsequent issues of the Canadian Journal of Occupational Therapy. After visiting the hospital in 1936, he predicted: “There is no doubt in my mind after seeing this Scotch institution, closely related as it is to the Royal Infirmary, but that it will become a centre for a school and a university course and that from this work, started by our Canadian aides, there will be a great development of occupational therapy all over Great Britain”.

Howland continued to extol the virtues of the Astley Ainslie for years to come. In his Presidential address of 1938, he describes what he considers “the six great boughs which have developed from the original trunk of occupational therapy in Canada”. Referring to the Astley Ainslie, he says: “Our most easterly bough, of some five years’ development, is in Edinburgh, Scotland where the finest pavilion for Occupational Therapy in the world, I believe, has been constructed on the hospital grounds”. He went on to say, “they have established the first fully organized school for Occupational Therapy in Great Britain and will graduate their first class in 1939, under the teaching of qualified Canadian therapists.” (Howland, 1938). On this last point, however, Howland was not correct as Dorset House school had already begun its educational program in 1930.

The workshops that Mabel designed were mentioned frequently. During a tour of the occupational therapy department given to members pf the Public Health and Maternity Committee of the Edinburgh Women’s Citizens’ Association, the purpose of the work was described and reported in the Daily Mail: “its purpose being that form of treatment which included any occupation, mental or physical, definitely prescribed and guided for the distinct purpose of contributing to and hastening recovery from disease of injury. The trained occupational therapy aide knew by experience how to select and apply the work best-suited to the particular object to be attained on (January 4, 1935).

Cunningham describes the occupational therapy work at the Astley Ainslie in the British Journal of Physical Medicine, in July 1936, writing that … “a new building specially designed for the purpose is nearing completion. Following modern practice, separate workshops have been provided for the “noisy” and the “quiet” crafts, so that patients requiring restful occupations may remain undisturbed by those to whom a more robust type of treatment has been prescribed”.

A decade or so later, with the injured soldiers of World War II a great concern, occupational therapy at the Astley Ainsley was newly applauded by Cunningham. When he delivered the Keith Lecture to the Royal Scottish Society of Arts, The Scotsman reported that “he drew attention to the impetus given to the rehabilitation of disabled people because of the …. increased social consciousness in recent years, and still more because of the urgent demands for manpower brought about by the war”. He added that the treatment may have a psychological, remedial or educative aim. Whenever possible, it should be started while the patient is in bed, to keep up muscle tone and to arouse interest in something outside the illness” (13 November 1944).

The outdoors provided an important component of treatment for patients at the Astley Ainslie. Mabel spoke of the importance of being outdoors whenever possible and designed verandahs on the OT pavilion for that purpose. Howland (1936) had also commented on the “splendid outside verandahs around the wholebuilding for summer work.” Gloria Langmaid Macdonald described the grounds saying, “Picture for yourself numerous bungalow units scattered in a business-like way over spacious grounds with flowers and trees everywhere.” The ‘30s were a time when nature was considered to be a great healer and a means to maintain well-being, with William Morris and the Arts and Crafts Movement having promoted its importance just a few decades earlier. Such non-medical approaches to promoting health were popular then even as they are again now, with a recent study published in the journal Environmental Research, concluding that greenspace exposure is associated with numerous health benefits (Twohig-Bennett & Jones, 2018). Artistic endeavours were also seen as therapeutic; craft activities encouraged patients to use their creativity in a social milieu where all levels of ability were accepted and considered meaningful.

Mabel left the Astley Ainslie in 1936 to join her husband in Southport, England where he had established a general practice. She had three children and never worked as an occupational therapist again. Dr McRae served in the Medical Corps during the war and they returned to Canada at its end. Mabel’s energetic spirit and her ability to lead were evident in the volunteer work she carried on in the years that followed; taking on executive roles in the parents’ associations at her children’s schools, volunteering with her church, the Toronto Symphony Orchestra, and the Imperial Order of the Daughters of the Empire.

In 1996, three occupational therapy students from the University of Toronto interviewed Mabel at her retirement home. The video shows an elegant 86-year-old woman, enthusiastically reflecting on the time she spent at the Asley Ainslie. “I look back”, she said, “and think I had one of the happiest times that anybody could ever have in their youth” (Comay, Bonnah, Parkinson, student video interview, 1996).

Mabel loved occupational therapy and the opportunities it gave her to be independent and to flourish. At age 86, following the Havergal honour, she spoke with great delight about her work at the Astley Ainslie. She said, “I threw my heart and soul into my career and I never understood why anyone wanted to pay me for something I loved doing . . . It was something that I reveled in” (Kelly, 1997).

When the Astley Ainslie celebrated its diamond jubilee Mabel was invited to return and plant a tree in her honour and commemorate the special pavilion she had designed. She was delighted to do so.