Public health perspectives on postwar mental health: gender, housing and family in Kitimat, British Columbia, 1950s.

Lucyk, Kelsey ; McLaren, Lindsay ; Stahnisch, Frank 等

The purpose of this study is to explore how mental health was understood and experienced in the context of the postwar period using the well-documented construction of the comprehensively planned, resource-based community of Kitimat, British Columbia (BC) as a case example. Today, Kitimat is home to a population of approximately 9,300 residents and is engaged in a number of major economic development projects in manufacturing, and oil and natural gas industries. In its earliest years, however, the economic situation in Kitimat looked much different. Established in 1953, Kitimat provides a unique opportunity to explore how this population of healthy workers and their families, living in an isolated place, understood and experienced mental health during the postwar period.

These findings represent one phase of a larger study, which explored how mental health was understood in relation to Kitimat's economic changes throughout the town's history (i.e., 1953-2010). (1) As will be shown in this paper, residents' understandings and experiences of mental health aligned with holistic definitions of mental health as currently defined by the World Health Organization (WHO): "a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community." (2) Mental health was also understood and experienced through gender roles, housing and family ideals (i.e., social determinants of health).

Postwar psychology, psychiatry and mental health

At the time when Kitimat was built, the North American professions of psychiatry and psychology were undergoing major changes, from treating the mentally ill in large, crowded psychiatric asylums to more individualized community-based care, talk therapy and psychopharmacology. (3) It was in this context of the postwar period that the WHO also introduced a stipulation for mental health to its Constitution. At the International Health Conference in June 1946, representatives from 61 countries defined health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." (4) By specifying that health (and mental health) was more than the absence of disease, this definition departed from the previous focus of psychiatrists and psychologists, which was clinical diagnosis and treatment of mental disorders, to a more holistic understanding.

[FIGURE 1 OMITTED]

The town of Kitimat provides a unique opportunity to explore this holistic conceptualization of mental health that emerged at the time. First, because Kitimat's population comprised young, healthy workers and their families, mental disorders during the postwar period were seemingly absent from its historical record. Accordingly, residents discussed mental health in ways that were more consistent with the WHO's focus on mental well-being rather than a clinical focus on mental disorders. Second, Kitimat was specifically designed with residents' well-being in mind, thus public observations and urban planners' concerns with social determinants of health and well-being have been uniquely prominent in this town's history.

The Kitimat Project

The municipality of Kitimat was established in 1953 through an agreement between the Province of BC and the Aluminum Company of Canada (Alcan), whereby Alcan would build a new, northern city in exchange for land and water rights to build and power its new aluminum smelter. These components of the Kitimat Project are illustrated in Figure 1. It is the comprehensive urban plan, combined with the large industrial projects implemented by Alcan, that makes Kitimat distinct from other mid-20th century resource-based "company" towns. (5)

The notion of a "company town" refers to a community built and owned by a company to house workers (and their families) while it manufactures or extracts a resource. (6) These towns are common to Canada's economic and urban development histories, given the country's reliance on natural resources (e.g., fish, fur and timber) for economic growth. (7) Historically, when resource stocks became depleted and extraction costs increased, companies moved out of the region and closed the operations of the town they had built. (8) Because of this process, residents of company towns often live with a sense of impermanence, which can negatively affect the community's commitment to place and its resilience in the event of a company closure. (6)

Alcan wished to avoid this fate, that had happened to other company towns in BC (e.g., former towns of Anyox* or Ocean Falls ([dagger])), so they hired a New York architectural firm, Mayer, Stein & Whittlesey, to design a comprehensively planned city that would have a future as a self-sustaining community. To further ensure that the town was independent of Alcan, the province incorporated Kitimat as its own municipality before construction of the town began.

The town plan of Kitimat was designed to be attractive to workers and their families, so as to retain a stable workforce for Alcan. The architects designed Kitimat with ample green space, pedestrian walkways, automobile routes, and separate neighbourhood blocks away from the industrial site. As stated in their plan for the community, "What we were really after was the life of the individual, the family, the group ..." (11) These emphases were furthermore apparent to outsiders; for example, a 1964 Canadian Geographic article featuring Kitimat called attention to how "young Sandra Wellin can play happily in one of the public parks ... Mrs. Wellin can cut household flowers from a garden ... [and] her husband is only 10 minutes from his work." (12) Planners also sought to create sufficient social infrastructure in Kitimat, without which, they deduced, the remote wilderness of Kitimat could create "frustrated and cross children [that] drive their mothers crazy; cross wives [that] frustrate their husbands." (11) Therefore, the planners used Kitimat as an opportunity to carve from the wilderness a town that comprehensively met the needs of their desired population: breadwinning husbands who would work at the smelter and provide for their families financially, homemaking mothers to raise children and transform newly constructed houses into happy homes, and obedient children to make use of Kitimat's new schools and playgrounds.

Theoretical framework

As will be illustrated below, these idealized norms conveyed in the planning and development of Kitimat, which themselves reflect broader postwar values, (13-15) played an important role in how understandings and experiences of mental health were manifested in this community. This relationship operates within the model presented by William Rohe, University of North Carolina professor of city and regional planning, who in 1985 argued that community design influences mental health according to the opportunities for social interaction and physical stimulation that they provide to residents. (16) By this criterion, we might assume that Kitimat would be the utopian suburbia that planners had envisioned insofar as mental health is concerned. Rohe expands, however, to consider that where the desire for interaction or stimulation is not met, individuals may experience a stress state, which may have long-term mental health consequences, especially if sufficient social supports are not in place. (16) As will be shown throughout this paper, Kitimat's long-term design created short-term problems for residents vis-a-vis mental health.

METHODS

A qualitative content analysis of Kitimat's historical documents between 1950 and 1960 was conducted. Documents (see Table 1 for examples) were retrieved from the archives of the Kitimat Public Library, the Kitimat Centennial Museum, and the District of Kitimat. This study follows the general methods of qualitative content analysis outlined by communications researcher Klaus Krippendorff from the University of Pennsylvania. (17)

First, documents were selected and compiled for analysis if they broadly addressed one or more of the themes in the WHO's holistic conceptualization of mental health (e.g., well-being, personal potential, life stress). Relevant documents were identified through consultation with the curator, archivist and archivist's assistant. Additionally, the databases for the archives at the Museum, and Special Collections and Northern Sentinel at the Library were searched using relevant key words (e.g., "mental," "psych*"). In total, over 500 archival resources were compiled for review, of which approximately 200 were relevant to the period of 1950-1960 according to a partial, purposive reading of the documents. The search and screening approach was deliberately broad in recognition that the language pertinent to mental health would change over time. The use of triangulation of documents from various sources helped to maximize the validity of the findings. (18)

Second, the approximately 200 potentially relevant documents were read in full and categorized according to common elements that became apparent (e.g., gender, housing, family), using NVivo 9 (QSR International, Doncaster). Documents that did not fit into relevant groupings were excluded. The remaining documents (approximately 100) were coded for thematic content vis-a-vis mental health (e.g., stress caused by housing situation). Codes and themes were then interpreted in relation to the WHO definition of mental health and the social context of the time (e.g., how an issue like housing contributed to one's ability to cope with normal life stresses).

Third, eight in-depth, semi-structured qualitative interviews were conducted face to face with long-term residents over the age of 18 who had lived in Kitimat since at least 1997. This year was chosen to ensure that residents had lived through at least one of Kitimat's major economic changes (e.g., the 2005 closure of a major industry). Snowball sampling was used to identify potential participants, whose identities were kept anonymous. Interviews ranged from 30 minutes to 2 hours and were recorded by digital audio recorder. Each participant provided informed consent. Interview questions asked participants about their experiences living in Kitimat (e.g., perceived community changes). Following each interview, recordings were transcribed and returned to the participant electronically, when they had the opportunity to exclude information. The transcripts were then imported into the dataset with historical documents and analyzed according to the criteria described above. Thus, through an inductive process, data from the two main sources converged to yield an overall set of findings.

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Throughout the analysis and data collection process, the lead author used the phenomenological reductionist method of bracketing, wherein "a researcher [attempts to suspend] his or her presuppositions, biases, assumptions, theories, or previous experiences ... by placing them outside the brackets, which then facilitates a focusing in on the phenomenon within the brackets." (19) This entailed recording personal convictions and experiences in an attempt to avoid making preliminary judgements about the data, given the lead author's role as a former resident of Kitimat. This maximized the scientific rigour of the study and also drew on her experience in understanding Kitimat's social context.

This study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (E-24677).

RESULTS AND DISCUSSION

What emerged through the interpretation of data sources was that Kitimat residents understood and experienced mental health through their daily ways of living. Specifically, mental health was interpreted in relation to gendered norms that reinforced the notion of an ideal family unit, which were experienced through issues such as housing, employment, and community living expectations, as conceptualized in Figure 2.

The gendered norms and family ideal promoted in Kitimat reflect a broader set of postwar values, whereby involvement in a middle-class, affluent and white-collar family was believed to protect against postwar anxieties like juvenile delinquency, divorce, or general concerns about the ongoing Cold War. (13) Furthermore, the postwar family ideal was believed to provide security for the future, with emphasis on home ownership, domestic tradition and child rearing. (15) Consequently, residents' barriers to mental health were identified as factors that prevented alignment with these ideals, such as housing shortages that separated families, or the unmet expectations of community living.

An overall comment about our findings is that they mostly concern women and appear to lack examples of positive mental health experiences. This is not surprising: Kitimat was designed and promoted as a suburban utopia for the modern housewife, thus it is understandable that the significant mismatch between desired conditions of living and the actual town was manifested in the experiences of women. While men certainly had their own experiences and understandings of mental health, the masculine discourses of strength and stoicism that dominated the 1950s likely prevented them from reporting such grievances as freely as women. This is a recognized characteristic of the archival materials used, for the texts themselves are a reproduced form of ideals and norms of the time. Similarly, the lack of more positive accounts of mental health, vis-a-vis daily living experiences, is a reality of our data. Where residents spoke positively about the new town of Kitimat, they did so mostly in looking forward to what the town would be, versus the construction conditions they were subject to in the 1950s.

Gendered norms

Archival documents show that Kitimat residents supported idealized gender roles, which explicitly characterized and implicitly idealized women as feminine, submissive, delicate and homemaking wives and mothers, and men as masculine, dominant, strong and wage-earning husbands and fathers. For example, the local newspaper, the Northern Sentinel, would showcase events like the opening of a modern supermarket to appeal to women (e.g., advertising bathrooms suitable for children or grocery carts with baby seats). (20) In fact, the layout of the Sentinel itself was structured according to gendered ideals. While the men's section of the paper had columns on fishing, sports and history, the Women's Page had recipes, housekeeping tips, fashion commentaries, wedding announcements and gossip columns. (21,22) There were, of course, exceptions, as some Kitimat women were not married and worked as wage earners. In most cases, however, these women worked in ways that were considered gender appropriate and compatible with the expectations of feminine domesticity; for example, widowed women who worked as boarding house "mothers," staff-house matrons, babysitters, telephone operators, dress shop attendants or waitresses. (23) As illustrated in the following paragraphs, these gendered norms influenced experiences of the community and in turn contributed to experiences of mental health.

Unmet expectations of community living

The then City Manager of Kitimat, Cyril Henderson (1918-1978), explained to a journalist in 195 7 that unmet expectations of community living were an extremely pervasive issue for Kitimat housewives. Husbands who had moved from other provinces or countries to work in Kitimat often persuaded their wives to join them by describing what the town would be, rather than its current state. Henderson related that while wives often expected a suburban utopia:

   If they hit the town in the rainy season and are led to some
   unfinished house with a sea of mud for a front yard, the shock can
   be nearly fatal. This is a workingman's town--a good one, we think,
   but not a fancy suburb. (24)

Though unmet expectations were widespread, they were arguably most acute for women, for whom these unmet expectations prevented performance of expected feminine roles. This, in turn, contributed to their understandings and experiences of mental health. One housewife described arriving at a new home in an unfinished community:

   I went to the door and opened it and saw only forest and [company]
   homes. I had a heavy weight in my heart [...] I see nothing that I
   recognize and no familiar faces around." (24)

In addition to the undeveloped forest that enclosed the urban dwelling, Kitimat's status as a town under construction (as exemplified through the mud, garbage and incomplete infrastructure) made it difficult for housewives to engage in the domestic duties (e.g., shopping, walking children, looking neat) necessitated by their women-as-homemaker gender role. A 1955 editorial published in the Northern Sentinel described the lack of bus shelters in the community as an impediment to participating in gendered activities:

   Kitimat should no longer be enduring inconveniences of a
   construction era--women and children must have their shelters after
   leaving warm houses to travel to schools and shopping centres. (25)

The above two statements reveal the widespread frustrations that Kitimat women experienced living in a new town while also trying to maintain their women-as-homemaker role. While the problems were seemingly minor issues, collectively they took their toll on housewives. Journalist William Worden, writing an article on Kitimat in 1957, describes:

   ... a teary blond wife, surrounded by furniture still in its
   packing cases, look[ing] out at a city that was conceived by
   experts, planned to the last street and garbage dump, and built
   that way. She shrugs and announces her findings, "This is a perfect
   city? Well, not for me. I'm getting out just as soon as I can. My
   husband can stay if he wants to but I'm leaving." (24)

Worden's article implies that the unanticipated experiences and unmet expectations of community living in Kitimat negatively contributed to experiences of mental well-being.

Housing shortages and mental health

The issue of housing was one of the most prominent factors that affected how Kitimat residents understood and experienced mental health. Because Kitimat had been constructed in stages of complete neighbourhood units, there was a long wait (up to many years) to secure housing. Many families spent this waiting period in temporary residences at the industrial site, in shared accommodations, or with husband and wife living in separate communities. This was a challenge for families, who expected and desired to begin their modern lives in Kitimat under the roof of a single-family dwelling.

Residents who did occupy Kitimat houses in the 1950s were often subject to poor living conditions as a result of rushed construction to meet the needs of the local housing demand, despite the architects' careful plans. Referring to unsatisfactory living conditions, Reverend Graham Tucker, a columnist and clergyman, wrote to the Northern Sentinel in 1955 a "factual statement of conditions as they exist":

"... it must be mentally depressing to have to live in a house in which water streams down the inside walls ... heightened by the fact that the house is brand new and is costing a lot of money." (26)

Tucker's article was prompted by the flooding of over 200 basements of brand-new Kitimat homes that occurred in the spring of 1955. His account shows that the poor workmanship of houses that were intended for affluent, middle-class families negatively influenced the mental health of those occupants.

The family ideal, employment and mental health

Because of the housing shortages and the wait for vacancies, the mother and children of some families lived in one town, and their breadwinner lived and worked in Alcan's camp, an arrangement that had implications for well-being. One account of these conditions comes from a "Very Lonely Family in Terrace" in its letter to the editor of the Northern Sentinel. Today, Terrace is just a 45-minute drive from Kitimat, but in the 1950s residents had to travel by scheduled rail, boat or plane trip. The wife of a smelter worker voices her frustration and near-desperation with housing shortages in this way:

   Did [y]ou ever hear the heart-breaking cry every Sunday, "Daddy
   don't go", by three kids who miss their Dad? Why can't company's
   [sic] at Kitimat build houses for decent married people? Why all
      the
   places for single men? They only stay a few months anyway, where a
   married couple would settle there IF there was a place to live ...
      (27)

In "Very Lonely's" letter, the author expresses a desire to begin life in Kitimat, together, as a family unit with a homemaking mother and working father. She also conveys a positive value judgement about marriage in her reference to a "decent married couple". Finally, this letter hints at familial stress due to slow construction in Kitimat, which was a typical experience for Kitimat families in the 1950s. Residents publicly engaged in conversations such as that of "Very Lonely" above, wherein they lamented their inability to live together as the ideal family unit, which they were led to believe was the typical Kitimat experience.

LIMITATIONS AND CONCLUSIONS

Perhaps the key limitation of this study, which is inherent to historical analysis, is its interpretive nature. Mental health was not explicitly discussed in the data sources; therefore, it was necessary to employ interpretive methods informed by contemporary definitions to adequately explore the issue of mental health. These methods permitted a deep and rich understanding of experiences and understandings of mental health in the context of the local circumstances of postwar Kitimat, a time and place for which population statistics are not available (though information related to mental health services for BC exists [since 1948], data for Kitimat specifically are not available for the time frame of interest). This limitation was reduced through use of triangulation (analysis of an array of sources, such as community organizations, long-term residents and the Municipal Council) to present a comprehensive and representative interpretation. (18)

The relative absence of explicit language in archival documents may reflect the strong and healthy population of Kitimat's early residents. The town's lack of mental health services may also have contributed to this apparent absence, while on the other hand the lack of services likely reflects the intended population (i.e., healthy workers) that Kitimat was designed to attract.

Historical inquiry helps in understanding complicated issues of the present, especially in a field as complex and multifaceted as mental health. (28) This study, in particular, has shown the importance of accounting for local social and economic circumstances in exploring how populations understand and experience mental health, for even with comprehensive planning, unexpected consequences may arise. The findings from this paper may be of special interest to those currently working collaboratively in public health and urban planning, (29) considering the current emphasis on designing and implementing strategies for healthy and sustainable communities in jurisdictions across Canada. Finally, it is important that we revisit historical examples, such as Kitimat, and consider the challenges that these communities have overcome, given the similar challenges currently faced by the Healthy Cities and Communities movement (e.g., social, economic, environmental, political and technological forces). (30)

As has been shown throughout this paper, the importance of idealized gender and family roles, combined with the reality of living in a town under construction, contributed adversely to mental health in Kitimat's population. For this study, housing and unmet community living expectations were issues through which feelings about mental health were expressed. This was particularly relevant to women, whose dissatisfaction spanned their roles as wives, mothers and new residents in Kitimat. It is important to systematically document these different experiences of mental health, even when epidemiologic data are not available, as a means of gaining a more complete understanding of the ways in which mental health may be expressed. More generally, this paper can inform other studies that explore mental health topics in times and places where and when contemporary language has been limited.

Acknowledgements: The authors thank Drs. Andrew G.M. Bulloch, Henderikus J. Stam and Peter Toohey, as members of Kelsey Lucyk's MSc thesis committee, for their valuable insight into this project. Special thanks are given to the staff of the Kitimat Museum and Archives for the support and guidance they provided to this historical work. Kelsey Lucyk is supported by an Achievers in Medical Science Scholarship. At the time of writing, Lindsay McLaren was supported by a Population Health Investigator Award from Alberta Innovates - Health Solutions. Frank Stahnisch is the Hannah Professor in the History of Medicine and Health Care at the University of Calgary, and has received student research support from the Alberta Medical Foundation.

Conflict of Interest: None to declare.

REFERENCES

(1.) Lucyk K. 'Growing Pains': An historical analysis of population mental health in Kitimat, British Columbia, 1950-2010. Calgary, AB: University of Calgary, 2013.

(2.) World Health Organization. Mental Health: A State of Well-being. October 2011. Available at: http://www.who.int/features/factfiles/mental_ health/en/index.html (Accessed October 23, 2013).

(3.) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 1952.

(4.) World Health Organization. Preamble to the Constitution of the World Health Organization. International Health Conference: Official Records of the World Health Organization. New York, NY: WHO, 1946.

(5.) Halseth G, Sullivan L. From Kitimat to Tumbler Ridge: A crucial lesson not learned in resource-town planning. Western Geography 2003/2004;13/14:132-60.

(6.) Herkes J. Planning for resilience: A case study of Kitimat, BC. Victoria, BC: University of Victoria, 2009.

(7.) Innis H. The Fur Trade in Canada. Toronto: University of Toronto Press, 1930.

(8.) Clapp R. The resource cycle in forestry and fishing. Can Geographer 1998;4:129-44.

(9.) Anyox Hydro Electric Corp. Anyox then. No date. Available at: http://www.anyox.com (Accessed October 23, 2013).

(10.) BC Archives. A brief history of Ocean Falls. No date. Available at: http://www.bcarchives.gov.bc.ca/exhibits/timemach/galler02/frames/ oceanhis.htm (Accessed October 23, 2013).

(11.) Stein C, Mayer A, Whittlesey J. Kitimat: A new city. Architectural Forum July 1954; 128-47.

(12.) McGuire B, Wild R. Kitimat: Tomorrow's city today. Can Geograph J 1959;59:142-61.

(13.) Gleason M. Normalizing the ideal: Psychology, the school, and the family in post-World War II Canada, 1945-1960. Waterloo, ON: University of Waterloo, 1996.

(14.) Seeley J, Sim A, Loosley D. Crestwood Heights: A Study of Culture and Suburban Life. New York: Basic Books, 1956.

(15.) Block T. 'Families that pray together, stay together': Religion, gender, and family in postwar Victoria, British Columbia. BC Studies 2005;145:31-54.

(16.) Rohe W. Urban planning and mental health. Prev Human Services 1985;4(1/2):79-110.

(17.) Krippendorff K. Content Analysis: An Introduction to Its Methodology. Thousand Oaks, CA: Sage Publications, 2004.

(18.) Farmer T, Robinson K, Elliott S, Eyes J. Developing and implementing a triangulation protocol for qualitative health research. Qual Health Res 2006;16(3):377-94.

(19.) Gearing R. Bracketing in research: A typology. J Qual Health Res 2004;14(10):1429-52.

(20.) Nechako Centre Food Store Open November 26. Northern Sentinel 1954 Nov 18:1.

(21.) Karpenter K. Kitimat Kolumn. Northern Sentinel 1954 Oct 21:9.

(22.) Bailey M. Margaret Bailey Writes...Northern Sentinel 1955 Aug 18:9.

(23.) Classifieds. Northern Sentinel. 1954 Nov 18:9.

(24.) Worden W. Incredible new frontier. Saturday Evening Post 1957 Feb 9:36-52.

(25.) Editorial. Northern Sentinel 1955 Nov 17:4.

(26.) Tucker. Letter to the Editor. Northern Sentinel 1955 Feb 3:8.

(27.) Letter to the Editor. Northern Sentinel 1956 Aug 17:2.

(28.) Rosen G. A History of Public Health. Baltimore, MD: Johns Hopkins University Press, 1993.

(29.) McCormack G, Shiell A, Doyle-Baker P, Friedenreich C. Subpopulation differences in the association between neighborhood urban form and neighborhood-based physical activity. Health Place 2014(28C):09-55. [Epub ahead of print].

(30.) Bezold C, Hancock T. The futures of the Healthy Cities and Communities Movement. National Civic Review 2014(Spring):66-70.

Received: November 29, 2013

Accepted: June 3, 2014

Kelsey Lucyk, [1] Lindsay McLaren, [1,2] Frank Stahnisch [1,3]

[1.] Department of Community Health Sciences, University of Calgary, Calgary, AB

[2.] Population Health and Inequities Research Centre, University of Calgary, Calgary, AB

[3.] Department of History, University of Calgary, Calgary, AB

Correspondence: Kelsey Lucyk, Department of Community Health Sciences,

University of Calgary, 3280 Hospital Dr. NW, Calgary, AB T2N 4Z6, Tel: 403-210 7210, E-mail: klucyk@ucalgary.ca

* Anyox was a company town owned by the Granby Mining Company and located in the Northwest region of BC; residents abandoned it in 1935, when the mine closed its operations. (9)

([dagger]) Ocean Falls, a community on the Central Coast of BC, was a remote company town that operated around a pulp and paper mill owned by Crown Zellerbach. Its 3,500 residents left when the mill closed in 1980, leaving a seasonal population of about 100 loggers. (10)

Table 1. Examples of format, type and authors
of archival resources

Type           Format

Books          Ethnography
               History
               Non-fiction
               Story collection
Minute books   Meeting minutes

Reports        Annual review
               Census profile
               Child care needs
               Community events
               Community needs assessment
               Financial/spending
               Social and economic transformations
Studies        Community resource usage
               Environmental/biological assessment
               Industrial impact assessment
               Land usage
               Neighbourhood development
               Retail market
               Shopping and commuting patterns
Other          Brochures
               Contracts
               Letters
               Speeches
               Yearbooks
               Museum exhibition notes
               Pamphlets

Type           Authors

Books          Community organizations Industries
               Local individuals
               Municipal Council

Minute books   Business organizations Community
                 organizations Municipal Council
Reports        Businesses
               Community organizations Industries
               Hospital
               Municipal Council

Studies        Academics
               Business organizations Consultant groups
               Community organizations Industries
               Municipal Council
               Union organizations

Other          Business organizations
               Community organizations
               Individuals
               Industries