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What Every Patient, Family,
Friend, and Caregiver Needs
to Know About Psychiatry

Second Edition
This page intentionally left blank
What Every Patient, Family,
Friend, and Caregiver Needs
to Know About Psychiatry

Second Edition

Richard W. Roukema, M.D., F.A.P.A.

Washington, DC
London, England
Note: The author has worked to ensure that all information in this book is ac-
curate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U.S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views
and opinions of the individual authors and do not necessarily represent the pol-
icies and opinions of APPI or the American Psychiatric Association.
Copyright © 2003 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
07 06 05 04 03 5 4 3 2 1
Second Edition
Typeset in Adobe Palatino and Formata
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Roukema, Richard W.
What every patient, family, friend, and caregiver needs to know about
psychiatry / Richard W. Roukema. – 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-58562-110-2 (alk. paper)
1. Psychiatry—Popular works. 2. Consumer education. I. Title.
RC460.R68 2003
616.89–dc21 2003052166
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
TO MY FAMILY:

My wife, Marge
Greg, Susan, Bennett, and Evan
Todd Richard
Jim, Meg, Jimmy, Jenni, and Chris

With love and gratitude


This page intentionally left blank
Contents
About the Author. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi

P A R T I
Background and Normal Variations in Stress

1 A Day at the Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 Normal Development and the Life Cycle . . . . . . . . . . . . . .19

3 Heredity, Parenting, and Society . . . . . . . . . . . . . . . . . . . . .31

4 Stress and Common Emotional Reactions . . . . . . . . . . . . .45

5 Managing Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

P A R T I I
How Emotional Illness Differs From Mental Illness

6 Adjustment Disorders and Psychosomatic Disorders . . . .71

7 Anxiety Disorders, Somatoform Disorders, and


Dissociative Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83

8 Alcoholism and Drug Abuse. . . . . . . . . . . . . . . . . . . . . . . .105

9 Sexual Problems in Our Culture . . . . . . . . . . . . . . . . . . . .121

10 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .143

11 The Emotional Effects of Loss . . . . . . . . . . . . . . . . . . . . . .161

12 Personality Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179

13 Unusual Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . .195


P A R T I I I
Mental Illness: The Psychoses

14 Mood Disorders: Depression and Manic States . . . . . . . .203

15 Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .221

16 Other Psychotic Disorders . . . . . . . . . . . . . . . . . . . . . . . . .235

17 Delirium, Dementia, and Amnestic and


Other Cognitive Disorders . . . . . . . . . . . . . . . . . . . . . . . . .239

P A R T I V
Treatment of Emotional and Mental Illnesses

18 How a Psychiatrist Helps . . . . . . . . . . . . . . . . . . . . . . . . . .255

19 Psychotherapy: Who, What, When, and How? . . . . . . . . .271

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .283

Suggested Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297
About the Author

RICHARD W. ROUKEMA, M.D., F.A.P.A., is Clinical Associate Professor at


the University of Medicine and Dentistry of New Jersey (UMDNJ) in
Newark, New Jersey. He also serves as Clinical Director of Mental
Health Services at Ramapo Ridge Psychiatric Hospital in Wyckoff, New
Jersey, a division of the Christian Health Care Center.
Dr. Roukema is married to Congresswoman Marge Roukema (R-
New Jersey) and has two children. He has published in numerous jour-
nals and has won many awards, including Psychiatrist of the Year from
the National Alliance for the Mentally Ill (NAMI–NJ Chapter) and a na-
tional award, a Special Teaching Award (Psychiatric Residents and
Medical Students) from UMDNJ–New Jersey Medical School, and the
Top Docs Award from New Jersey Monthly magazine.
Dr. Roukema has been granted a certificate of Distinguished Life
Fellow by the American Psychiatric Association.

ix
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Introduction

We are living in post–September 11 times. Although some individu-


als seem little affected and are walking through life as though nothing
happened on that day in 2001, most of us are looking through different
lenses and experience more anxiety and sadness than in previous days.
The United States and its leaders anticipate more terrorism. No one
knows when such blatant acts of destruction may occur. Persons with
emotional or psychiatric disorders are especially affected by such major
events, and the result has been more frequent use of mental health ser-
vices. As expected, the incidence of depression, generalized anxiety,
and, especially, posttraumatic stress disorder has increased.
Simultaneously, it is becoming more difficult to obtain mental
health services because of restrictions by commercial and government
insurance sources. To counter this trend, the U.S. Congress is attempt-
ing to pass a mental health parity bill, which would prevent discrimina-
tion by insurers in payments for such services.
Among insurance companies, questions always arise regarding
what kinds of problems can be considered diseases. The major clinical
disorders, such as schizophrenia, bipolar disorder, and major depres-
sion, are clearly debilitating illnesses and thus require insurance re-
imbursement. But should difficulties in marriage, vocational stress, or
lesser issues be treated by the mental health community? Or should
such conditions be regarded simply as problems in living? At present,
most of these conditions are covered (at least in part) by insurance. But
this situation may not continue as costs increase.
The role of psychiatrists has changed drastically in the last 20 years.
During most of my private practice, I was a single practitioner who saw
patients weekly or more often in full 50-minute sessions. Such practice
is becoming less common. Most psychiatrists now engage in split treat-
ment. Psychiatrists evaluate new patients and then conduct weekly or
monthly 10- to 15-minute medication checks. Meanwhile, mental health
specialists are assigned to perform the psychotherapy. This new ar-
rangement works well when there is close collaboration between psy-
chiatrist and psychotherapist. However, there is often insufficient
monitoring of medication use.
xi
xii What Every Patient, Family, Friend & Caregiver Needs to Know

Physicians are now considered “health care providers” and are no


longer regarded as the sole source of information on health care. Maga-
zines and newspapers have columns on the latest treatments for many
diseases. The Internet is a competing source of data on health issues. Pa-
tients often come to physicians’ offices with downloaded information
that they intend to compare with what their physicians say. The use of
alternative medicine, also referred to as complementary medicine, is in-
creasingly common. Physicians now routinely ask their patients if they
are using any such medications or techniques such as acupuncture, bio-
feedback, or massage therapy. Herbal medicines are taken with aban-
don, and many persons believe that these substances are “natural” and
therefore are not drugs or chemicals. The new research on herbal drugs
is gradually revealing that some are useful and others are of no use or
even harmful. In this age of rapidly changing research findings and
new treatments, it is no wonder that the average patient wants to know
what the best treatment is at the present time for a given illness.
With less time to talk to psychiatrists about what is currently avail-
able, patients and families of those with psychiatric illnesses do well to
seek out information about the mental health field.
This book provides the latest such data. In this edition, recent ge-
netic findings regarding mental illness, new diagnostic techniques, and
new brain scan techniques are presented. I also discuss recent alterna-
tions in psychotherapeutic techniques and new medications with fewer
side effects. With the increase in the incidence of Alzheimer’s disease, it
seemed appropriate to include a broader discussion of this devastating
illness and its effect on caregivers. As in the first edition, helpful sugges-
tions are made to family and other caregivers concerning what they can
do to help the person who is striving to cope with an emotional or men-
tal illness. Recommendations for further reading on specific topics are
provided at the end of the book.
I am pleased that there has been sufficient interest in this book to
warrant a second edition, as well as a Chinese translation. I hope that
patients and families will find the information useful in understanding
and dealing with any emotional or mental illness in their lives.
I thank Robert E. Hales, M.D., M.B.A., Editor-in-Chief of American
Psychiatric Publishing, for agreeing to have me author a second edition
of this book. I appreciate all the work of APPI’s professional publishing
staff, including Ron McMillen, Chief Executive Officer; John McDuffie,
Editorial Director; Pam Harley, Managing Editor, Books; Anne Barnes,
Graphic Design Manager; and Judy Castagna, Manufacturing Manager.
I thank Herbert Pardes, M.D., for graciously providing a quote for use
on the book’s cover.
P A R T I

Background and
Normal Variations
in Stress
This page intentionally left blank
1
A Day at the Office

We all have our days when nothing seems to go right. We all get anx-
ious, fear certain situations, and avoid conflicts. It is part of being alive
and human. Some people expect to be happy all the time, and they com-
plain about it when they are not. But such expectations are not realistic.
We all experience sadness at some time or another. Loss is common to
everyone and must be endured. Stress is familiar to us; it is our constant
companion, and it must be handled in appropriate ways in order to pre-
vent anxiety. Dealing with these everyday situations is part of life.
Most of us handle the normal stresses without experiencing too
much anxiety, depression, or physical stress. But many exceptions exist.
A man or woman may work at the same job for many years and never
complain about the stress that is encountered each day. Then suddenly,
something happens that is out of the ordinary and it overwhelms the in-
dividual. Just such a situation happened to Jill, a successful 45-year-old
accountant. No stress at work had ever been too much for her. Then one
day her boss asked her to go to court to testify about some records that
the company had maintained. She was simply required to report on
work that the company had done in the past. Jill’s own work was not
being questioned. She only had to report on some accounting figures.
She was not going to be cross-examined or held responsible for any of
the documents. Yet her reaction to this new problem was overwhelm-
ing. Jill became anxious and depressed. She could not sleep through the
night. Her days were filled with worry and concern about the court ap-
pearance. Jill began to worry about whether she was losing control and
maybe even losing her mind. She required only a short period of coun-

3
4 What Every Patient, Family, Friend & Caregiver Needs to Know

seling and medication to gain control of her feelings. After the court ap-
pearance was over, she resumed her normal activities and was no
longer under stress.
Temporary excesses in stress are common. We all have times when
our lives may be touched by excessive anxiety. No one escapes an occa-
sional anxious time. Some are able to take stress and anxiety in stride
and require no outside assistance. Many people are able to deal better
with stress and anxiety by using various self-help methods such as ex-
ercise, yoga, and relaxation techniques. Others suffer more and may
need help from mental health specialists. Such help is available from
many sources, from self-help groups to psychotherapists. A psychiatrist
can help to distinguish between the stress that is common to all and the
more intense symptoms that require psychiatric treatment. In addition,
a psychiatrist is helpful in carefully prescribing medications. In more
severe situations, individuals may need admission to psychiatric units
in general hospitals or psychiatric hospitals. But it has not always been
so. Psychiatrists, psychologists, social workers, and other counselors
are a twentieth-century phenomenon. They were hardly known in pre-
vious centuries.
In ancient times, mental and emotional illnesses were viewed by
most individuals as rooted in a spiritual problem, which required a
spiritual solution. The local clergy, with their religious customs,
prayers, and rituals, were consulted for assistance. Consulting with
clergy also occurred during the Middle Ages. But persons with mental
illness, who were regarded as insane, were treated poorly; they were ex-
cluded from society and often placed in dungeons. In the eighteenth
century, French physician Philippe Pinel improved conditions and
placed the mentally ill in buildings suitable for care. During the Amer-
ican Revolution, Benjamin Rush treated mentally ill patients in a hospi-
tal in Philadelphia. From his written record, it is clear that he had a firm
grasp of mental illness; he understood and described the behavior and
thoughts of the mentally ill very well. Treatments, however, were quite
primitive. Bloodletting, purgatives to rid the body of “poisons,” and
ice-water baths for shock effect were in common use. Still later, during
the nineteenth century, each state built hospitals for the care of the men-
tally ill. Many of these institutions still remain, although the population
in them has been remarkably reduced.
Meanwhile, the everyday problems that most people experienced
were worked out either with the use of home remedies or with help
from family members, friends, the clergy, or local physicians. At the
time, a severe stigma about mental illness existed. People were ex-
pected to either handle their own problems and deal with their own
A Day at the Office 5

stress or receive minimal help from those around them. Any sign of
mental illness in a person was perceived by others with extreme fear, or
the person was avoided or ridiculed. Although these attitudes were
prevalent in the past, such stigma remains, despite vast improvements
in the field of mental health.
The era of modern psychiatry did not begin until the latter part of
the nineteenth century. It was then that Sigmund Freud came to the con-
clusion that illnesses such as anxiety, hysteria, and emotionally induced
paralysis of muscles were caused by mental conflicts and that bringing
these issues into the patient’s awareness helped eliminate symptoms of
these neurotic conditions. Through his work and that of his followers,
the modern era of psychoanalysis and psychotherapy began.
Much later, another important development occurred. During the
early 1950s, new medications were produced for active treatment of the
major psychiatric disorders, such as schizophrenia and bipolar disorder
(formerly called manic-depressive illness). This was the beginning of a
biological revolution in the field of psychiatry. No longer were physi-
cians helpless in treating these disorders. This development of medica-
tions led the way to treatment of debilitating mental and emotional
illnesses with medication and counseling. The modern psychiatrist now
has a wide array of therapies from which to choose for the care of his or
her patients.

Common Questions
Psychiatrists caring for the emotionally or mentally ill are asked many
questions by family members and friends about caregiving. Among the
typical questions are “What do I do when my wife becomes panicky?”
“Should I push my husband to go to work even when he is depressed?”
“What do I say when my elderly mother thinks someone has stolen her
shoes, when she has forgotten where she has placed them?” Someone
else might ask how to manage the strange behavior of a relative who is
schizophrenic but living at home. Such questions are asked by relatives,
friends, and others on the front lines—those who are trying hard to deal
with the emotionally or mentally ill. Teachers, clergy, and various
health care workers often are not knowledgeable or secure enough to
feel that they are doing the right thing in handling the distressed per-
son. Such concerned and involved persons want to be helpful. They of-
ten worry about whether their communications and actions are going
to assist the person in need or be detrimental.
Although information alone often is not sufficient to help those
who are in contact with the emotionally or mentally ill, knowledge
6 What Every Patient, Family, Friend & Caregiver Needs to Know

about such illnesses can be a basis or starting point for dealing with dis-
tressed individuals. For example, dealing with an alcoholic person may
be confusing and frustrating if one is not familiar with the disease. But
the information obtained by a member in Alcoholics Anonymous or by
a family member in Al-Anon can be extremely helpful. Similarly, some
familiarity with psychiatric disorders is useful to those who are dealing
with these problems on a daily basis.
It is not unusual for an individual to request a consultation with a
psychiatrist about a particular problem that is mild or in its early stages
(e.g., “I just wanted to check it out to see if I am on the right track.”).
Some problems are not serious and may require only one or two ses-
sions to resolve. Not everyone needs a prolonged period of psychother-
apy or treatment with medication for his or her distress. But there are
difficulties in living that people experience that are not so easily dis-
missed.
In this book, both the common stresses of everyday life and the
more complicated psychiatric problems that are seen in the psychia-
trist’s office are discussed. Whenever possible, useful suggestions are
given for each disorder to help patients and their relatives or other care-
givers understand the nature of the difficulties that they may encounter
and how to deal with them.
The following section is an overview of the typical problems that
are brought to the consulting room of the psychiatrist. The illnesses and
concerns presented are common to patients who are seen every day by
psychiatrists engaged in private practice or working in clinics through-
out the country.

Common Problems in Psychiatry


Case Example
It happened all at once. When she least expected it, Anne became ex-
tremely anxious and upset. She was enjoying herself at a concert in New
York City, listening attentively to the orchestra. Suddenly she experi-
enced a profound physical sensation. It was difficult to breathe, her
heart was pounding, and she felt weak and was certain that she would
faint. Her head began to spin, and she felt completely out of control. She
knew that she had to get out of the concert hall at once. Anne tugged at
her husband’s arm and told him that she had to leave. He was surprised
by her insistence, because he had no idea that she was having a panic
reaction. They left the hall and started for home. As they were traveling
up the West Side Highway toward the George Washington Bridge, Anne
began to feel better, but she still felt weak and anxious. On arriving
home, she immediately poured herself a few ounces of vodka to allevi-
ate her tension. The next day, she called her physician and made an ap-
A Day at the Office 7

pointment. He examined her and found her to be in good physical


condition, although her pulse rate was slightly increased. He assured
her that she was in fine health and that her symptoms were due to anx-
iety. Anne felt momentarily satisfied but worried that an “attack” would
recur.
Several days later, while shopping at a supermarket, Anne had an-
other episode. It was a repetition of the same distressing feelings, only
worse. This time she thought she would lose her mind. She rested at the
market for a while and then went home. Anne called her physician and
told him the news. He asked her to come into his office again. The phy-
sician found nothing that indicated any physical disease and suggested
that she call a psychiatrist.
The very word psychiatrist brought to mind other worries. Anne
wondered, “Am I going to have the same problem that my uncle had?
He was in a mental hospital for years. Is this the way it begins?” Now
she became even more anxious. Anne called her husband at work, told
him about her visit to the physician, and asked him what to do. When
he became aware of her fear and anxiety, he told her that he would be
home shortly and would arrange to take her to a psychiatrist.
The road to my office seemed long. The anxiety did not dissipate at
all during the ride. But shortly after Anne arrived at my office, she asked
the questions that were most on her mind: “Doctor, am I going crazy?
Am I going to have to go to a mental hospital?” After hearing about the
symptoms, it was apparent to me that she had a typical panic disorder.
I assured her that she was not going crazy and that I had never seen any-
one become insane following symptoms such as she was experiencing.
When she heard this statement, she felt immediate relief and began to
relax. But then she asked, “Will it come back?” I informed her that such
symptoms may recur but that there are good medications that can help
alleviate the symptoms and prevent attacks from returning. I also told
her that we should meet again to investigate the possible origin of her
panic attacks. She agreed to do so, and treatment began.

Phobic Disorders
For reasons that are unclear, phobias have become prevalent in today’s
culture. These abnormal fears are present in a high percentage of the
population. Many people simply avoid the feared object or situation
(e.g., elevators, escalators, snakes) and thus never ask for treatment for
their phobias. Others rationalize their phobias. Someone who is afraid
to fly might say that his or her friends are stupid for flying, because it is
dangerous. But some phobias can be disabling, particularly if they in-
terfere with a person’s vocation. For example, a truck driver who sud-
denly develops a phobia about driving is more strongly affected than
someone who is not dependent on driving for his or her economic well-
being. Phobias sometimes disappear spontaneously; others remain for
a lifetime.
8 What Every Patient, Family, Friend & Caregiver Needs to Know

As a response to the increase of phobias in our culture, phobia clin-


ics have been established in most major cities in this country. In addi-
tion, psychiatrists and other psychotherapists treat many patients with
phobias, and they do so successfully. New treatments using medication
and behavioral techniques have largely replaced the traditional use of
psychoanalysis, although in some cases psychoanalysis is still a good
long-term approach to the problem of phobic symptoms.

Mood Disorders
Changes in mood come on suddenly or gradually and are upsetting.
Perhaps you know of a friend or relative who has experienced acute de-
pression. You may have witnessed the profound lack of energy, the loss
of appetite, the difficulty sleeping, the feelings of despair, and even the
rumination about suicide. Depression in another person makes the on-
looker feel helpless. A typical case example illustrating depression
follows.

Case Example
A 55-year-old executive came to see me because of a dramatic change in
mood; he was markedly depressed. A few weeks before, Bill had been
making major decisions in his position at a large Fortune 500 company.
Bill wondered how this could happen to him. Wasn’t he a dynamic per-
sonality? How could he suddenly become so depressed that he could
not make even small decisions anymore? His appetite had all but disap-
peared, and sleep was almost impossible. His mood was hopeless; he
wondered how he could ever return to work and assume any responsi-
bilities. His family was equally surprised at his condition, for they had
never seen him like this before. It was apparent that he could do little,
although his wife struggled to get him to do some household chores.
Even simple tasks were beyond his ability at the time. The days were
long and dreary; suicide was very much on Bill’s mind.
At the suggestion of a friend, Bill’s wife made an appointment for
Bill to see me at my office. Bill did not want to come, but at his wife’s
insistence, he reluctantly came for a consultation. It was apparent that
Bill had a serious depression and needed immediate treatment. Because
of his suicidal ideas, it was necessary for me to hospitalize him in a psy-
chiatric unit of a general hospital, where he could be given appropriate
medication and could be watched for changes in his condition. He reluc-
tantly accepted my recommendation that he be hospitalized. At first, he
remained depressed and unable to do anything to help himself, but
gradually he began to respond. In 3 weeks, he was well enough to
go home, where he took maintenance doses of medication. Within
2 months, he was back to work part-time, and in another month, he was
fully functional.
A Day at the Office 9

Such cases of depression are common. This type of depression can


happen to anyone. It is serious and can be brought on by external prob-
lems or occur for no apparent reason at all. In the last 30 years, psychi-
atry has made great strides in dealing with depression, with more
success during this short period than in all previous centuries.
Some individuals with depression also have times when they feel
unusually well, have an enormous amount of energy, and feel “high.”
Frequently, while consulting with someone in my office, I have been
asked, “Do my mood swings mean that I am a manic-depressive?” This
is an important question, particularly if there is a history of such illness
in the family. It is essential for the psychiatrist to distinguish between
day-to-day fluctuations in mood that are common and within normal
limits and the massive mood swings seen in patients with bipolar dis-
order (formerly called manic-depressive illness). This illness has been
researched extensively and has been found to be inherited and to have
a biological basis. In the past, many patients with bipolar disorder had
to be hospitalized for long periods. Now the devastating effects of this
disorder are controlled successfully in a high percentage of patients
with the use of lithium and other medications.

Drugs and Alcohol


Many patients have questions about the disease of alcoholism. “Is alco-
holism inherited?” “My father was an alcoholic. Does this mean that
I am more likely to become an alcoholic?” “If I drink alcohol, will my
children be more likely to drink?” “Can you become an alcoholic if you
only drink beer?” “Why doesn’t my husband realize that he is an alco-
holic when it is so obvious to everyone else?” Most psychiatrists are
able to answer these questions well.
It has taken the general physician a long time to admit to the trag-
edy that results from the excessive use of alcohol. Driving under the in-
fluence of alcohol is a well-recognized cause of mortality. Diseases such
as cirrhosis of the liver, inflammation of the pancreas, withdrawal reac-
tions (delirium tremens), and certain forms of heart disease are also the
result of excessive alcohol use. Although physicians have known that
these conditions are caused by alcohol use, there has been a reluctance
in the past to confront the alcoholic person about his or her illness. The
more recent acceptance of alcoholism as a disease rather than just a bad
habit has done much to point the way toward rehabilitation and treat-
ment programs for people with alcoholism. The combination of medical
treatment and Alcoholics Anonymous is effective in dealing with alco-
holism.
10 What Every Patient, Family, Friend & Caregiver Needs to Know

During the first half of the twentieth century, the use of mind-alter-
ing drugs was confined to the inner city and to certain artists and per-
formers. But in the last 30 years, an epidemic of drug use by teenagers
and young adults has taken its toll in illness and premature deaths. The
public has been assaulted with information in the media; at times it has
been confusing.
Currently, much more is known about the effects of street drugs on
physical and mental health and how these drugs interfere with the abil-
ity to function well. New treatments have evolved, and the importance
of self-help groups such as Alcoholics Anonymous and Narcotics
Anonymous cannot be overemphasized.
Patients frequently ask questions about the use of prescribed med-
ications. “Will taking a drug make me dependent on it? Will I be able to
get off it or will I have withdrawal effects?” It has been my experience
that when someone is that concerned about the problem of drug depen-
dence, the psychiatrist does not have to worry about that person be-
coming dependent or addicted. Rather, such individuals have to be
encouraged to take enough of the medication for it to be effective; such
persons are so afraid of addiction that they tend to skip doses.

Changes in Marriage
Marriage problems appear to be increasing in our society. When I first
began my practice some years ago, I read a book titled Neurotic Interac-
tion in Marriage. It highlighted the fact that individuals are attracted to
each other for conscious as well as unconscious reasons. For example, it
is not unusual for a quiet, shy, introverted person to be attracted to a
talkative, extroverted individual. In such an instance, each person sees
in the other traits not possessed by the self. But these attractions are not
always recognized consciously when the two individuals first meet.
The attraction occurs nevertheless. Probably no marriage exists without
a degree of “neurotic” involvement between the partners. This involve-
ment is generally outside one’s awareness. This is not to say that it is ab-
normal. Rather, it is one of the reasons attraction, infatuation, and love
are so powerful. To a large extent, this involvement is healthy and is of
no concern to the psychotherapist. But when the neurotic interaction is
intense, it can sometimes become destructive.
Marriage has proven to be a difficult institution; less than half of the
population appears to manage it at all. Perhaps only one-third of mar-
riages function well. Furthermore, the expectations of marriage part-
ners have changed over the years, and the commitment to marriage has
altered remarkably. Many people come to psychiatrists or other psycho-
A Day at the Office 11

therapists for counseling about marriage problems. Some ask how to


change the other person. Others want to know how to change them-
selves in order to adjust to the other person. If the marriage partners are
genuinely motivated to remain married and are committed to improv-
ing their relationship, much can be done to facilitate the process and
make the marriage work.

Problems Common to the Elderly


A number of physical disorders bring on psychiatric symptoms; these
symptoms are seen most commonly in the elderly. For example, a pa-
tient may have a sudden onset of dizziness, disorientation, difficulty re-
membering things, and a general loss of control. These symptoms may
last a short time and gradually clear up. They are disturbing to patients,
and the patients may feel that they are “going crazy.” Usually these
symptoms are due to a circulatory problem and may portend more se-
rious symptoms in the future, such as a cerebral hemorrhage or throm-
bosis resulting in a stroke. Frequently, however, patients have only one
episode and live quite well for years without further difficulty.

Case Example
One day, I was called into the local hospital to see an elderly woman. Sa-
rah had been admitted for an abdominal condition, and she had been
functioning well mentally before her admission. The evening after she
came to the hospital, she began to have symptoms that were frightening
to her. She became markedly disoriented; she thought she was in her
childhood home. She called for her mother, who had long since died.
She misidentified the nurses as her sisters and even had trouble calling
her husband by name. Sarah’s memory was severely impaired, and she
was extremely anxious. She did not remember my name and appeared
to confuse me with someone else. She gave her full name correctly but
could not name the hospital, even though she had been quite familiar
with it. Her husband could not comprehend the changes that had oc-
curred in such a short time. But after only 2 days of care and appropriate
medication, her condition began to stabilize, and within 2 more days,
she was mentally healthy again.

As in this example, some types of acute organic psychoses can come


and go quickly. But to the patient and the family, these events are very
distressing. In recent years, the incidence of Alzheimer’s disease has in-
creased markedly in the general population. This illness involving
memory impairment and mental decline affects patients and family
alike. It is discussed in detail in Chapter 17 (“Delirium, Dementia, and
Amnestic and Other Cognitive Disorders”).
12 What Every Patient, Family, Friend & Caregiver Needs to Know

Fear of Mental Illness


Many people have trouble making up their minds about things. Every
day, we all have to decide on small or large issues. Some individuals can
make decisions instantly and seem to have few regrets about their deci-
sions. Others, by contrast, appear to be ambivalent about many issues.
Fred was such a person.

Case Example
Fred obsessed about everything. No decision seemed easy for him. One
day he was bothered by conflicting feelings about his wife. He said that
some days he loved her very much but other days he could not stand the
sight of her, although he would never tell her how he felt. On a particu-
lar day when he was in my office, he appeared unusually worried. After
much hesitation about the subject, he revealed his concern. “I can never
make up my mind about things. I don’t even feel the same about my
wife from one day to the other. Am I a ‘split personality’?” It was not
hard to guess the next question: “Am I schizophrenic?”

Many people confuse the terms split personality and schizophrenia.


They are not at all the same condition. Schizophrenia is a severe mental
illness in which various functions of the mind are affected to some de-
gree while other areas remain intact. For example, the patient may be
clearly oriented as to the current date, time, location, and his or her
identity and have a disturbance in thinking that makes his or her ideas
vague and unclear. Or the patient may be delusional, as in paranoia; he
or she may hear voices that others do not hear. Split personality, by con-
trast, is an illness in which multiple personalities are manifested at dif-
ferent times, as in the movie The Three Faces of Eve. It is a rare and often
debilitating illness. Fred did not have either of these disorders. Rather,
he had more difficulty making up his mind than most individuals do.
The reason for this was explored in psychotherapy. A psychiatrist can
help clarify the doubts and fears about severe illness, such as those that
Fred had, thereby alleviating the patient’s anxiety.

Psychoses
Some individuals are unfortunate enough to have the most troubling of
all psychiatric illnesses. This group of disorders is generally referred to
as the psychoses. Illnesses and events such as schizophrenia, bipolar
disorder, paranoid disorders, and brief psychotic reactions are ex-
tremely disturbing to patients and family alike. To lose control of one’s
thinking processes, to be unable to react appropriately to social and
A Day at the Office 13

work situations, to perceive what others do not see or hear, and to be


unable to react emotionally to others are symptoms typical of psychoses
and are truly the most difficult experiences that any human being can
endure. Probably the worst of these illnesses is schizophrenia. About
1% of the population develops this form of mental illness at some time.
It is debilitating in its effect on personality, performance, thought pro-
cesses, and emotional reactions. Some forms of schizophrenia come on
suddenly; others come on slowly and insidiously. There are acute man-
ifestations and more chronic forms. Some patients are docile, but others
are extremely active and can create major disturbances in families and
in the community. Regardless of the type of schizophrenia, there are far
more effective treatments available now than at any time in the past.
Antipsychotic medications now used in the treatment of psychoses di-
minish patients’ emotional pain.
Research on medications for treating the major psychiatric illnesses
has increased greatly during the last 40 years. The biochemistry of the
brain is becoming increasingly clear, although brain research is still at a
primitive stage compared with what is expected in the next 50–100
years. Many medications have been developed, and each year newer
drugs appear for management of the major psychoses and other psychi-
atric illnesses. Researchers hope to eventually find cures for these dis-
orders.

Multiple Symptoms
Sexual difficulties, reactions to loss, personality disorders, and behav-
ioral quirks are commonly seen by psychiatrists. Occasionally, some or
all of these problems can occur within the same person.

Case Example
Some time ago, a young, recently married man, Jack, consulted me
about premature ejaculation, a common sexual difficulty among young
males. He wanted specific help with this functional difficulty, but at the
same time he spoke of his terrible feelings of loss. He felt that his man-
hood was diminished, that his wife would no longer respect him, and
that she would divorce him. These feelings resulted in a degree of de-
pression. He wondered if he were strange and unusual. He asked
whether he was the only one to have such a difficulty. Was it a person-
ality problem? Was he losing control or losing his mind? Such thoughts
troubled him constantly. I assured Jack that of all the sexual difficulties
that can befall men, premature ejaculation is probably the easiest to
treat, if the person comes for help early. I also assured him that the
doubts and fears that he had were temporary side effects of his primary
concern—the sexual dysfunction. After about 6 months of psychother-
14 What Every Patient, Family, Friend & Caregiver Needs to Know

apy, he was functioning well sexually, had regained his self-respect, and
was not troubled by his thoughts.

The loss of the ability to perform sexually is one form of loss, but
losses can be experienced in many ways.

Other Losses
Human beings are subject to a variety of losses, such as the loss of loved
ones and the loss of prestige, position, financial security, and one’s job.
People react to such losses in many ways. Some handle the losses with
dispatch; others mourn losses and are depressed for months or years;
still others deal with loss by the excessive use of alcohol or other drugs.
There are persons who resort to suicide, thus ending the torture of de-
pression, feelings of helplessness, and low self-esteem. However, most
people handle loss with mild reactions of mourning, depression, insom-
nia, and anxiety. These symptoms usually disappear in time. Many peo-
ple consult clergy, friends, or self-help groups when dealing with loss.
When an extreme reaction to loss occurs, it is a good time to seek help
from a psychiatrist.

Personality Disorders
People with personality disorders do not often seek help from psychia-
trists. They usually are not bothered by their particular personality
traits, but these same traits often present difficulty for people around
them. For example, an individual with a paranoid personality is gener-
ally a quarrelsome, doubting, suspicious person. Yet he or she will sel-
dom go to a psychiatrist for help. The schizoid person is quiet and
withdrawn, is given to much daydreaming and fantasy, and has poor
interpersonal relationships. Such an individual will hardly ever seek
counseling on his or her own, even though the need for therapy may
seem obvious to friends and relatives. Similarly, the aggressive or the
narcissistic person rarely seeks out assistance from a psychotherapist.
Individuals with these personality types create much anguish and
distress in others. As a result, the psychiatrist often will see the husband
or wife of the individual who has the personality problem, because it is
the family member who all too frequently becomes the object of the pe-
culiar behavior of the person with the personality disorder. The relative
may ask, “How do I handle him when he does these outrageous
things?” “What do I do with her when she withdraws and does not
want to talk to me or see anyone?” Personality differences are often the
source of problems in families and in the workplace.
A Day at the Office 15

Modern Stress
Many persons are concerned about the general problem of anxiety and
how to cope with the increasing stresses of modern society. The recent
acts of terrorism in New York and Washington brought on another level
of anxiety among Americans. The cold war with Russia has evaporated
and has been replaced by terrorism. How much this new development
will increase the nation’s anxiety is not yet known.
It has been said that this is the age of anxiety. It is difficult to know
whether life today is more stressful than life 100 years ago or at any time
in history. We tend to romanticize the past and think of it only in favor-
able terms. But when a little thought is given to the distant past, it is not
hard to imagine the physical price humans paid on a daily basis just to
stay alive. They had to carry water from the well, use the outhouse,
wash clothes by hand, read by candlelight or gas lamp, ride horses or
ride in carriages, eat with little variety in menu, and perform hard phys-
ical labor for 10–12 hours a day. Many children died in infancy; mothers
frequently died during or shortly after childbirth. And many people
died of infections. I do not think that life was easier in the good old
days. Nor was it less stressful in an emotional sense. But there was one
significant difference: all people were forced to exercise their muscles
whether they wanted to or not. To survive, people had to do much more
than push buttons. Using the large muscles of the body may well have
drained away much of the anxiety that was consciously felt by people.
Now we resort to jogging, swimming, walking, or some other form of
exercise to compensate for the loss of such activity.
A certain amount of anxiety is normal, but excessive anxiety is an
abnormal state of arousal. Excessive anxiety has all the physical ingre-
dients of a readiness to fight or run away. Exercise will partially relieve
anxiety, but it is up to the person to try to deal with the causes of his or
her excessive anxiety. Most often, anxiety is due to emotional problems,
but sometimes the cause is a physical disease such as hyperthyroidism
or hypoglycemia. If the origin is physical, the anxiety must be handled
by a physician familiar with the particular physical problem. If the anx-
iety appears to be due to stress and emotional factors, help can be some-
times obtained through self-help books or organizations; often, the help
must be obtained through consultation with a mental health profes-
sional.
Stress and its various manifestations can lead to psychosomatic
problems. Many physical diseases are greatly influenced by stress. Ail-
ments such as headaches, stomach ulcers, colitis, thyroid disease,
asthma, and neurodermatitis are worsened or even caused by stress.
16 What Every Patient, Family, Friend & Caregiver Needs to Know

The same can be said of pain. Regardless of the origin of pain—even if


the pain is due to organic factors—stress tends to increase the amount
and frequency of pain.

Changes?
Has the overall incidence of emotional and mental problems increased
in modern times? This question is difficult to answer definitively, al-
though some changes are notable (e.g., the increase in the incidence of
posttraumatic stress disorder). Certainly, we know more about these ill-
nesses now than in the past and can do more about them. It is a common
observation among physicians that as new treatments are found for an
illness, many more patients are discovered for treatment of that illness.
This finding was noted particularly with the discovery of lithium for
the treatment of bipolar disorder, antidepressants for depression, and
medications and behavior modification for panic, anxiety, and obses-
sive-compulsive disorders.
Despite the improved treatments available, much mystery, mythol-
ogy, and confusion remain about the field of psychiatry. There is still
considerable stigma and fear about emotional and mental illnesses, al-
though there are signs that understanding and acceptance are increas-
ing among the general public and that the stigma regarding these
illnesses is decreasing.

Overview
The purpose of this book is to help readers differentiate between the
normal range of stresses and anxieties that are common to us all and the
types of illnesses that can occur and are seen day to day by psychia-
trists. With a basic knowledge of psychiatry, the parent, husband, wife,
or other family member, as well as the teacher, health care worker,
clergyperson, or police officer—those on the front lines—will be better
equipped to deal with the emotionally or mentally disturbed person in
an understanding way. Patients will benefit from knowledge of these
illnesses as well. Although the information provided is generally ac-
cepted by the majority of psychiatrists in this country, it should be
borne in mind that the field is continually changing as new discoveries
are made.
In succeeding chapters in this book, I discuss normal development
in general, hereditary considerations, parenting, and the current effect
of society on human development. I also discuss daily stresses and how
to cope with these stresses. A major focus of this book is specific psychi-
atric disorders and how they are treated.
A Day at the Office 17

Throughout the book, I present a number of observations on vari-


ous subjects based on my personal reflections. These observations are
not to be regarded as absolute fact. Changes that have occurred in the
treatment of various disorders over the years are acknowledged.
Suggested readings, organized by chapter, are provided at the end
of this book so that readers can gather more details about a given sub-
ject if desired.
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2
Normal Development
and the Life Cycle

When my children were growing up, I was in awe of the rapid


changes in their growth, the sudden discoveries of newfound abilities,
and the dramatic alterations in their emotional development. From
their complete dependence at birth, to lively interaction throughout in-
fancy, to seeking out partial independence as toddlers, they, like all chil-
dren, were a marvel to behold. The careful negotiating of a step, the
demand for food or care, the first assertive “no,” and the joy of play in
any form—these are some of the many things that I remember fondly.
At present, I am living through another part of the life cycle, as a
grandfather. Watching my grandchildren is even more fascinating. To
update my grandchildren’s parents, I visited several bookstores for the
latest information on child care.
The bookstores that I frequent are filled with new information on
child development and child care. Unlike a few generations ago, when
books by Spock and Gesell were the only sources that parents had to
consult, today’s parents have an abundance of books to read. If you
have children or grandchildren, you will recognize the different stages
of development that I summarize in this chapter. This information is
taken from various authorities in the field of child development. I have
not tried to cover every theory but have chosen what stands out in my
experience as important. For greater detail, I suggest reading books and
articles about this interesting topic.

19
20 What Every Patient, Family, Friend & Caregiver Needs to Know

Overview of Human Development


Normal human development occurs in two ways, depending on how
one views the subject. From one perspective, it consists of continuous
development, beginning in childhood and proceeding along a pre-
ordained path common to all people. One step follows another in well-
defined ways. Freud’s psychosexual stages and Erikson’s eight stages
of man fit into this category. From another perspective, development
appears to occur in spurts, with occasional regressions. In some individ-
uals, there is no forward movement in development at a given time, and
they may remain fixed psychologically at a particular stage. But it is
also possible that growth left unfinished in a previous stage is partially
accomplished in succeeding stages. Thus, some developmental stages
are never fully achieved, and others are delayed but eventually reached.
Both views are useful to consider in studying normal growth and devel-
opment.
Pediatricians, psychologists, and psychiatrists have conducted
many studies to help define what happens in the growing child. Biolog-
ical growth in terms of size, neurological change, and motor develop-
ment has been measured. Normal ranges for all these areas of
development have been described. Endocrinological, psychological,
and cognitive development also have been studied. Even the typical de-
velopment of language and morality in the growing child has been ob-
served and delineated.
Before modern times, human development was taken for granted.
Even if babies survived birth, many did not live through their first year
of life. If they were fortunate, they grew up to become adults. Infections
and epidemics often took the lives of the young. Unlike today, child-
hood ended early, at age 11 or 12 years or younger, at which time the
young person was expected to begin working to help adults cope with
the immense amount of physical labor necessary for survival. The pro-
longed adolescence that we now permit is a modern invention. With af-
fluence and the need for more education, whether technical or
academic, young people have become more dependent on their fami-
lies, resulting in the extension of adolescence. Some young people do
not begin to contribute toward their own support until they are in their
late 20s or early 30s.
During the nineteenth century, there was little interest in develop-
ment from infancy to adulthood. It was not until the last part of the
nineteenth century that Freud began to talk about the stages of devel-
opment.
Normal Development and the Life Cycle 21

Freud’s Psychosexual Stages


Sigmund Freud was perhaps the first person to attempt to delineate in
a systematic way the stages through which a child passes. He was con-
cerned with the biological events of childhood and the corresponding
emotional changes in the developing child. From his studies of the neu-
rotic adult, he theorized stages of development through which each
child passes. Furthermore, he postulated that if a child remained too
long at any one stage, his or her character and emotional life would be
altered or inhibited in the future. For example, fixation at the oral stage
of a child’s development could result in excessive dependence on oth-
ers, and fixation at the anal stage could bring about obsessive-compul-
sive behavior.
The oral stage begins at birth, when the infant has already acquired
the need to suck and turn its head (rooting reflex) in the direction of the
source of food. Without such an obvious instinctual move, the child
would not survive. But with it comes the closeness of the infant to the
mother. The child is fed, and simultaneously the mother is helping the
child develop psychologically. Holding, caressing, rocking, and talking
to the child are of enormous importance in the child’s development.
Studies of children in orphanages, where care by adults was extremely
limited, have shown that children who are not attended to emotionally
and are not picked up, caressed, and held appear to become withdrawn
and depressed. Some of the children studied died, even though no ob-
servable physical disease was present.
The regular and sufficient supply of food to the infant, along with
the necessary nurturing, gives the newborn the security that he or she
needs. If something interferes with the normal process during this
stage, an arrest in development occurs. Thereafter, the child may be
concerned excessively with satisfying oral needs, both physically and
emotionally. As a result, conditions such as obesity, anorexia, or bulimia
may occur in adolescence or adult life. If the conflict over the satisfac-
tion of needs is mild, there may be some compensation made in later
stages. But if the problem is severe, pathology results. Oral fixation and
excessive dependence on others may occur in adult life.
The anal stage begins at about 18–24 months. It centers around
bowel training. It is the time when the child is able to protest and say no
to parental wishes. If the parent is concerned with early bowel training,
the child may resist, and conflict will result. The child can withhold his
or her feces, play with them, appear to regard them as his or her posses-
sion, and not part with them easily. For some parents, especially the
more fastidious, this is cause for concern, whereas other parents deal
22 What Every Patient, Family, Friend & Caregiver Needs to Know

with such matters more casually. Some children pass through this stage
easily. Others take considerable time to do so, even when parents have
successfully worked through this stage with siblings. I have seen chil-
dren who were still soiling their pants at age 6 or 7 years because of a
failure to negotiate this stage successfully. Such behavior is clearly ab-
normal. I have known parents who delayed bowel training up to ages 4
and 5 years, with the permissive view that the child will use the toilet
for bowel movements when he or she is ready. During my psychoana-
lytic training, I reported such a delay of bowel training by a mother,
whose 5-year-old child had not yet been trained. My Viennese-born su-
pervisor responded with alarm, “When do these parents expect ego de-
velopment to begin?”
Freud stated that fixation at the anal stage of development results
in excessive concern about money, time, dirt, and germs in adulthood.
He maintained that if fixation at the anal stage occurs, traits such as ob-
stinacy, miserliness, and orderliness develop to form the obsessive-
compulsive personality.
The phallic stage begins at about age 3 years. At that time, the child
becomes increasingly interested in the genital area. Freud spoke mainly
about male interest in the penis and the child’s fascination with the
pleasure that he experiences in manipulating the genital area. He pos-
tulated that some male children develop castration anxiety and fear dur-
ing this period and that female children are subject to penis envy, or envy
of what the male child can do. There was little scientific basis for
Freud’s conclusions, but the theories about early sexuality have re-
mained in the psychiatric literature as authentic dogma. Some psychia-
trists see castration anxiety and penis envy not as actual problems for
children but as metaphors or symbols for what happens emotionally
during these periods.
During the phallic stage, the male child wants the exclusive atten-
tion of the mother, to the exclusion of the father, a situation that ushers
in the oedipal stage of psychosexual development. The healthy male
child negotiates this stage by gradually identifying with his father and
taking on the father’s values as his own. If the male child remains at-
tached to his mother too long and identifies with her too much, neurotic
conflicts and problems in character development may occur.
The latency stage follows at about age 7 years and continues until
puberty. Freud believed that during the latency stage, the child is less
concerned with sexual matters and more involved with mastering his
or her environment and with games, toys, school, and peers. This in-
volvement occurs, according to Freud, because of the child’s fear of cas-
tration and his or her repression of sexual desires. Although children
Normal Development and the Life Cycle 23

are preoccupied with these other activities at this stage, few psychia-
trists now believe that sexual interests are truly placed on the back
burner. During this stage, children are curious and play various explor-
atory games such as “doctor” and mutual masturbation.
Finally, with the onset of puberty, the genital stage arrives. Genital
gratification takes on prime importance. During this stage, the parents
of the child recede into the background and assume less importance,
and peers become the main focus of attention. The stage is now set for
the active pursuit of sexual “objects” and the eventual development of
mature sexual responses and relationships. Freud did not go on to de-
scribe other stages of the life cycle. He believed that the early stages
pave the way for future character traits and behavior and that adults re-
peat in a compulsive way the patterns laid down in childhood, a phe-
nomenon that Freud called repetition compulsion.
Freud’s developmental scheme is based on a biological form of re-
latedness—that is, on the fulfillment of biological needs. Later, other
psychoanalysts (Abraham, Horney, Sullivan, Fromm, and others)
stressed the emotional interactions that occur between the child and the
significant persons in his or her life. They believed that such relation-
ships were far more important than the specific psychosexual events
that occurred at any given stage. They called attention to the impor-
tance of the child’s culture and education and to the influence of his or
her peers, teachers, and other environmental factors. Thus, they did not
adhere to Freud’s biological basis of child development but were more
impressed by the multitude of factors that influence the child’s devel-
opment.

Erikson’s Eight Stages of Man


The well-known psychologist and psychoanalyst Erik Erikson pro-
vided a broader and more enlightened view of how children develop at
various stages. He enlarged on Freud’s biological approach with a more
inclusive description of the stages of man throughout life. He related
the biological instincts to the psychological factors occurring at the var-
ious stages. Erikson emphasized the parental, social, and moral influ-
ences on the individual. He believed that it was important for the
developing person to manage certain tasks successfully at each stage in
order to go on to the next stage.
Erikson postulated that the first stage is the oral-sensory stage: trust
versus mistrust/hope. During this stage, the child’s behavior consists
mostly of incorporating things. The infant takes in food orally and takes
in information from the environment through sight and other senses. If
24 What Every Patient, Family, Friend & Caregiver Needs to Know

the child’s caregiver regularly provides proper nourishment and ade-


quate physical and emotional care, the child will develop a basic feeling
of trust. Erikson stated that it is equally important for the infant to learn
to mistrust those around him or her who do not provide the basic needs
or who appear to do the infant harm. Later, the perceived balance be-
tween trust and mistrust develops into a crucial ability to discern be-
tween those peers and adults who have the child’s best interest at heart
and those who are out to do physical or emotional harm. Thus, Erikson
provided a psychosocial dimension that built on Freud’s original con-
cept of the oral stage of psychosexual development.
From the basic trust-mistrust relationship that evolves in the early
stage of life comes the virtue of hope. Everyone is familiar with the say-
ing “Hope springs eternal in the human breast.” Erikson postulated
that hope has its origin in the oral-sensory stage of life. It is the expec-
tation that good things are ahead, that needs will be met, and that life
will be satisfying. That trait is very human—the hope that exists even in
the most devastating circumstances such as in concentration camps or
in the presence of severe illness. It has always been amazing to me how
hope can exist in people who are going through such extreme trauma.
Only in the case of clinical depression does hope sometimes disappear
entirely.
In speaking of hope as a virtue, Erikson theorized about the origin
of other virtues, such as industry, purpose, and will—qualities seldom
referred to in the writings of psychiatrists and psychoanalysts. Refer-
ence to such virtues is one of the unique contributions of Erikson’s ap-
proach to child development.
During the second and third years of life, the child reaches the mus-
cular-anal stage: autonomy versus shame/doubt. The toddler gains mobility
and simultaneously begins to have a sense of purpose. In watching my
grandchildren at this stage, I have commented to my wife, “They have
their agenda.” There are goals in mind that are pursued one after the
other. Erikson said that this is the stage in which the child’s will be-
comes manifest. As a result, there is a battle between the will of the child
and that of the parents (consider the legendary “terrible twos”). Theo-
retically, if children are excessively controlled at this stage, they may
doubt their own wills, doubt their abilities, feel shame, and develop an
exaggerated conformity to those around them. On the other hand, fail-
ure to control some children’s impulses at this stage may lead to lack of
ego control on the part of the children. It is necessary for parents to give
children a degree of structure within which they can grow effectively
without having their wills thwarted excessively. The way to accomplish
this goal is the subject of many books on child rearing.
Normal Development and the Life Cycle 25

Erikson emphasized that the failure to successfully negotiate any


one of these stages may be partially overcome by good relationships
and experiences in future stages. Erikson referred to the phallic stage as
the locomotor-genital stage: initiative versus guilt/purpose. It occurs at
about ages 3–5 years. During this time, the male child becomes increas-
ingly interested in his genitals. He is consumed with his ability to move
about and to manipulate his environment. He develops initiative and
self-motivation. He idealizes his parents, which sets the stage for his
oedipal attachment to his mother. Similarly, the female child develops
the aforementioned abilities, but she relates adoringly to her father. At
this stage, exaggerated guilt on the part of a child of either sex may oc-
cur because of conscious or unconscious wishes to be close to one par-
ent. With the introduction of guilt, moral development begins, and a
rudimentary conscience is first seen. This oedipal attachment may last
inordinately long and prevent normal relationships with peers in ado-
lescence or in adult life. At this stage, the child also develops a greater
sense of purpose—a direction and goal toward which he or she strives
even in play.
The next stage occurs at age 5 or 6 years and extends to puberty.
Erikson called this the latency stage: industry versus inferiority/competence.
Although there is considerable interest in sexuality during this stage,
sexual interests are certainly not as great as they are after puberty. Dur-
ing the latency period, children are absorbed in learning as much as
they can about their environment. They attempt to master their sur-
roundings physically and mentally and to become competent in dealing
with whatever confronts them. Erikson spoke of this stage as a time for
industriousness. If children fail to accomplish what they set out to do,
they may develop a feeling of inferiority. By contrast, repeated suc-
cesses generate confidence and enable them to go on to more difficult
tasks.
The final stage of psychosexual development proposed by Freud is
the genital stage, which occurs after puberty. At this stage, the sexual
energy of the adolescent is directed toward someone usually of the op-
posite sex. Erikson referred to this stage as the adolescent stage: identity
versus role diffusion/fidelity. It is the task of the adolescent to try on one
“mask” after another to see which is to his or her liking. Eventually, the
adolescent feels comfortable with one mode of being—with one iden-
tity. Simultaneously, he or she develops the virtue of fidelity—the abil-
ity to hold an allegiance to a particular view or ideology. Identity and
fidelity together with the successful passage through the previous
stages lead to the formation of a strong sense of self (ego). In Erikson’s
words, “adolescence is really representative of what each individual’s
26 What Every Patient, Family, Friend & Caregiver Needs to Know

ego strength must tackle at one and the same time, namely, inner un-
ruliness and changing conditions” (Evans 1967, p. 33). Most adolescents
are able to meet this inner turmoil and survive quite well. If the individ-
ual is not successful in working out these changes and developments,
the ego is left weak and confused.
In our relatively free and affluent society, adolescents have an un-
usual number of choices from which to select their goals. The adoles-
cent’s identity is closely connected to the person, group, or activity with
whom or with which the adolescent identifies. Even two or three gen-
erations ago, the choices were relatively few. Previously, one could
choose to go from high school to the workplace, to go to college for fur-
ther education, or to enter military service. Today, there are many more
options. Spending a year or two traveling, studying abroad, entering a
commune, joining the Peace Corps, being a ski bum, and living at home
with parents are among the many choices that adolescents now make.
Without affluence, and the influence of the media, which highlight
these opportunities, these possibilities would not exist. Increased
choices mean more difficulties in terms of adolescent identity forma-
tion. But more creative potentials also exist.
Freud did not extend his psychosexual stages beyond the genital
stage (i.e., puberty.) Erikson went on to describe the young adult stage:
intimacy versus isolation—love.
As background to Erikson’s young adult stage, it is appropriate to
mention an observation by the American psychiatrist Harry Stack Sul-
livan. It was his opinion that at age 5 or 6 years, the child is able gradu-
ally to develop a “love” relationship with a friend, usually of the same
sex, at a time when he or she can care for and give to another person out
of feelings for that individual. Sullivan called this the “chum” stage of
development. He believed that this ability to regard a peer as a best
friend is essential to the future development of adult intimate relation-
ships. During this early time, the child is able to share his or her posses-
sions and exhibit some concern for the welfare of the other person. I am
certain that this stage is quite important for the adult to reach the inti-
macy necessary for a relationship in adult life. Erikson stressed the idea
that true intimacy and love require genuine care and concern for the
other person. Often, these qualities supersede the person’s own imme-
diate needs, and the identities of the two are somewhat fused toward a
common good. Ideally, the identities of both should complement each
other to their mutual benefit. If one person’s identity is too heavily in-
volved with the other, the relationship may become strained.
To be fully adult, the individual must be able to become intimate
with another person and feel and act in a genuinely loving manner. Fail-
Normal Development and the Life Cycle 27

ure to do so leads to isolation, but this does not mean that everyone who
is unmarried or not living intimately with another person has not
reached this stage successfully. It is quite possible to be loving and car-
ing toward others while not living with them. In our society, most indi-
viduals choose some form of cohabitation, but there are many single
persons who are fully adult, have intimate relationships, and are not
isolated. Such arrangements usually involve some form of commitment
to the other person.
At Erikson’s next stage, the adulthood stage: generativity versus stag-
nation/care, the adult contributes to society at large. He or she may pro-
duce an idea, create a work of art, raise a family, be inventive, or in some
way help the groups or institutions with which he or she is associated.
Each person has the potential to generate something. Failure to do so in
adult life results in stagnation of development of the person’s growth
potential. I have seen individuals who showed no further emotional or
intellectual growth after their early 20s. Some people in their 40s seem
to have lived their lives as fully as they ever will, reaching stagnation in
midlife. In contrast, some active persons continue their productivity
well into old age. Erikson himself was one such person.
The act of caring for others, including friends, family, the environ-
ment, or the world at large, requires a degree of maturity and genera-
tivity. Such caring serves as the cement that holds together the various
elements of society.
Erikson’s final stage, the old age and maturity stage: ego integrity versus
despair/wisdom, focuses on the ability of the ego to gather the experiences
and accomplishments of the past into a satisfactory whole. The person
in old age reflects on the past with a degree of wisdom that was not
present to the same extent before this stage. This wisdom does not occur
in everyone; it is an ideal. Many persons fall into despair and fret about
the inability to do the things that were possible in youth. Regrets, wor-
ries, and insecurities enter the elderly person’s life and interfere with
any wisdom or ego integration that might have been possible. But for
some, this can be a time of insightful reverie, integration, satisfaction, so-
lace, and equanimity. It does not have to be a time of regret and despair.

Sequential Separations
The life cycle can also be seen as a series of separations leading to vari-
ous forms of healthy growth or to insecurity and isolation. Each period
of separation may cause stress in and harm to the individual or provide
the opportunity for further maturation.
Separation begins with conception, when the fertilized egg sepa-
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201, 1139 Bay -Cierine (wid Frank) h 271 Old Weston rd --Cls L
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h 202A Holborne av (EY) --Josephine r 88 Wellesley e — Melvin r D,
247 Ossington av --Ottie (wid Jas) h 55 Rockcliffe blvd (York Twp) --
Richd mach Ideal Eread Co h 72 Chamberlain av (York Twp) —Alex
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Regent (York Twp) --Alex yardmn Sumner Equip r 398 Scarlett rd —
Alex M h 61 St John’s rd w (Wstn) — Alex M Jr slsmn Natl Cash
Register r 61 St John's rd (Wstn) t-, - o v i tr — Allan plant
Silverwoods r 7 Howland av -Ai,anf™‘LE s & a Robinson h 191
Greenwood . Queensway (Etob) --Wm H serv stn attdt Shell Oil Co h
D, 247 Ossington av Dunke Carl B elk Cities Service Oil h 10, 15
Delano Court (Scar) --Floyd W with Kroehler Mfg h 15 Strath av
(Etob) --Kenneth emp Simpsons h 156 Walmer rd Dunkelberger
Jacob A r 35 Sunnylea av e (Etob) Dunkelman Ben vice -pres, treas
& mgr Tip Top Tailors h 8 Robinwood av (Fst H) — Danl (Danny’s
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Ann (wid A R R) r 104 717 Eglinton av w (Fst H) --Annie (wid C L)
bkpr Tor Hunt Club h 126 Fallingbrook rd (Scar) — Arthur C chkr
CNR h 178 Cosbum av (EY) — Arthur G elk CPR r 16 Hart av (Scar)
— Betty Mrs switchbd opr Empire Acceptance Corp r 6, 196 Eglinton
av e — Bros (Mrs Irene Dunlop & Arthur J Coltham) credit clothiers
2090 Danforth av --Bruce drvr Eatons r 194 Indian rd -Bruce emp
CNR r 58 Struthers (Mim) -David pres W R Johnston & Co Ltd r 53
Russell HU1 --Bruce studt r 203 Glencairn av road --Ernest dir &
prod mgr Tip Top Tailors h 71 Stayner av (Nth Y) --J B & Co (Jos B
Dunkelman) woollens & linings 4th fir, 77" Wellington w --Jos B h 49
Burnside dr --Jos B (J B Dunkelman & Co) h 415 Rosemary rd (Fst H)
—Lome S mgr & slsmn J B Dunkelman h 103, 22 Shallmar blvd (Fst
H) --Louis h 1634a Bathurst (York Twp) — Moe emp Tip Top Tailors
h 100 Burnside dr --Paul ctr Tip Top Tailors r 13 Raglan av (York
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Dunkerley) 225 Gledhill av (EY) Dunkin Constance R nurse Tor
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180 Old Orchard gr — Harry dsgnr Design Craft Ltd h 477 Rosewell
av --Walter emp Candn Gypsum Co h 46 Portage av (Nth Y) Dunkl
Frank chemist Daly-Arrow Ltd h 156 Golf view avenue Dunklee Frank
L drvr slsmn Silverwoods h 56 Ritchie av — Jack conciliation officer
Dept of Lab (Ont) h 91 Charleswood dr (Nth Y) Dunkley A shpr
Aladdin Industries r 14 Dillcn av (Etob) — Albt W h 169 Oakwood av
(York Twp) — Bernard A steel wkr Massey -Harris h 14 Dillon av
(Etob) --Bruce W opr TTC h 16 Chester av --C Jessie Mrs priv sec
Osier, Hoskin & Harcourt h 40 Melrose av --Edith A tchr General
Mercer Pub Schl r 199 Glenholme av (York Twp) — Evelyn Mrs hlpr
Browns’ Bread r 18 Bushell av — Fred clnr CNR h 125 Coleman av —
Geo G bkbndr Blackhall & Co h 87 Strathcona av — Gerald B acct
Royal Bank h 2E Bexhill Cts (Etob) — Granville emp A V Roe h 69
Savona dr (Etob) — Harold W Income Tax h 12 Parkhurst blvd (Leas)
— Jack M drftsmn Chemical Construction h 311, Unit 5, 415 Lake
Shore rd (Mim) — Jas R dept head Hugh Mackay & Co h B2, 3017
Queen e (Scar) --John R customs agt MacLean Hunter r 40 Melrose
avenue — John R slsmn Royal Securities r 199 Glenholme av (York
Twp) — Lola officer S A Territorial Hdqtrs r 471 Jarvis --Margt M Mrs
elk Bank of N S r 519 Huron --Marion tchr General Mercer Pub Schl r
169 Oakwood av (York Twp) --Myrtle (wid Wm) h 18 Bushell av —
Richd h 199 Glenholme av (York Twp) --Ruth elk United DeForest
Cleaners — Sidney J comp Star h 2947 St Clair av e (EY) — W
Gordon E asst mgr Can Life h 153 Eastbourne avenue --Wm G bkr
Westons h 20 Condor av Dunklin Chas emp C W Mack r 7 Bruce —
Margt Mrs h 7 Bruce Dunkl ing Catherine tchr Runnymede Pub Schl r
2 Lydon av (York Twp) — Geo pdlr h 39 Scarlett rd (York Twp) --Geo
C mach Modern Tool Works h 2 Lydon av (York Twp) — Henry brklyr
H Paukstye h 18 Homeview av (York Twp) --Joan elk Osier &
Hammond r 393 Scarlett rd (Wstn) --Rosetta (’wid Henry) h 585
Jane (York Twp) — Wm G emp Phoenix Engnmg r 2 Lydon av (York
Twp) Dunklman Sarah (wid Aaron) r 475 Grace Dunko Alec r 161
Gerrard e Dunland Open Kitchen (Kuzo & Foto Lambroff) 1745
Dundas w Dunlap Jane r 80 East Lynn av --Ralph emp A V Roe h 412
Montrose av Dunlavey Allan h 17, 34 Rosecliffe av (York Twp) --Wm
mgr Columbia Hotel h 272 Roncesvalles av Dunlea Jas M opr TTC h
174 Phyllis av (Scar) Dunleavy Geo h 17 Maple Grove av --Jeanne W
Dept of Mines (Ont) r 268 Poplar Plains rd --Michl bus drvr TTC h 96
Frater av (EY) --Patrick const Swifts h 47 Auburn av --Raymond
engnr Swifts r 47 Auburn av Dunlevie Gerald A schl tchr r 2, 50
Montclair av (Fst H) --Marguerite (wid A) elk Bank of Mont h 2, 50
Montclair av (Fst H) Dunlevy Albt J dist sis mgr Tor Fuels h 40 Alder
rd (EY) --Eldon emp CNR h 1038 Lake Shore rd (New T) --Robt r 18
Chesley av Dunlop Abraham mfr agt h 82 Kelsonia av (Scar) —
Agnes priv sec Goodyear Tire h 104, 717 Eglinton av w (Fst H) --Alan
D slsmn Zenith Elect Supply h 6, 196 Eglinton av e --Albt E
vehiclemn C P Exp res Richmond Hill — Albt H sign writer Frank
Jackson & Co h 228 Geoffrey --Alex drvr Simpsons r 111 Regent
(York Twp) — Bruce J emp CNR r 151 Sheldrake blvd — C J elk
Noranda Mines r 248 Heath w — Catherine (wid Thomson) h 37
Baiiacaine dr (Etob) — Charlene M elk Procter & Gamble r 24
Copeland avenue --Chas P sr adjuster Singer Sew Mach h 113
Queens dale av (EY) --Clinton set up man Acme Screw & Gear h 12
Castleton av (York Twp) --Cyrilla elk P O r 44, The Maples s s Bain av
--Daisy r 178 Cosbum av (EY) — Danl opr Sumner Equip r 29 Jasper
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David emp Bawden Industry h 36 Spencer av --David with Bell Tel h
4 Barrington av --Dean asst aud Peters Brown & Co r 146 Albany av
— Donald kitchen steward r 48, 588 Trethewey dr (Nth Y) --Donald
maintenance asst Samuel Son & Co r 167 A r gyle — Donald pmtr A
& P r 701 Dupont --Donald A district chief Fire Dept h 91
Hammersmith av — Donald M art dir Spitzer & Mills h 67 Gothic av
— Donald S with Moore Corp res Port Crqdit — Doreen compt opr
TTC h 30 Fairholme av (Nth Y) — Doreen C radio time buyer Young
& Rubicam r vb Balmoral av --Doreen V E elk East York Twp r 51
Durant av (EY) --Doris emp Acme Paper Co h 2, 143 Ontario —
Douglas chkr & pekr Colgate Palmolive h 46 Holly dene rd (Scar) --
Douglas trk drvr M J Campbell Ltd r 3 Pendrith --Edwin suprvsr
Wilson’s Ginger Ale h 8 Wellesley avenue — Eileen M elk Ont Hydro r
11 Wellesley av — Eleanor F (wid John H) h 17A, 43 Metcalfe —
Elizth maid r 38 Burton rd (Fst H) — Ella (wid Jas A) h 288 Indian rd
— Emily h 196 Oakmount rd --Esther h 196 Oakmount rd — Evelyn
(wid Robt) r 104 McRoberts av --Evelyn R stenog Moloney Elect r
104 McRoberts avenue --F Clifford acct Grolier Society h 131 Fairview
av — F J Rev h 103 Briar Hill av — Florence r 228 Geoffrey — Ford
emp Frigidaire h 58 Amsterdam av (EY) --Fred r 362 Huron — Fred
W r 18 St Joseph —Frdk T cash h 794 Adelaide w --Garnet G chart
acct h 101 Strathallan blvd — Geo emp Swifts r 296 Huron --Geo H
suprvsr Simpsons h 772 Sammon av (EY) — Geo H tech Gutta
Percha h 37 Baiiacaine dr (Etob) --Geo S emp Sunnybrook Hosp h
145 Withrow av --Gerald r 755 Brock av — Geraldine G Mrs elk Bank
of Mont r 2, 226 College —Gloria accounting elk Dom Mutual his
Agency r 178 Cosbum av (EY) —Gordon H elk TTC h 10 Berl av
(Etob) --Grace (wid Thos) h 180 George --Grace emp New Method
Laundry r 21 Keystone avenue --Grace insp Rogers Radio h 852A
Millwood rd (Leas) — H foremn Milnes Coal r 701 Dupont --H Irene
tchr r 28, 2 Glen Elm av --Harley pmtr Eatons r 85 Hepboume --
Harold bkpr Gage Paper r 21 Dear bourne av — Harold D with Bell
Tel h 68 Caims av — Harry freight handler CNR h 10 Portland —
Harry G freight handler CNR h 2 Coxwell av s --Harry J E retail
merchandising asst Imp Oil h 449 Durie — Hazel sec -treas J K
MacLeod & Co h 16, 487 Duplex av — Helen emp Work Comp Bd r
103 Briar Hill av — Helen I tchr Western Tech-Comml Schl r 2 Glen
Elm av --Helen N opr Christies Bread r 65 Brookdside av (York Twp)
— Herbt elk Metro -Goldwyn -Mayer r 11 Wellesley avenue --Herbt I
elk Gas Co h 62 Beechborough av (York Twp) --Herbt W wood carver
h 77 Golfview av — Herman W lab h 56 Clovelly av (York Twp) —
Hugh M suprvsr Weather stone Aluminum Windows h 9 Louvain av
— Hugh R trust officer Crown Trust h 28 Bowood avenue — Ida r 47
Thursfield cres (Leas) — Irene Mrs (Dunlop Bros) h 1604 Danforth
av --Irvin r 30 Twentieth (New T) — Irving C life underwriter London
Life res Scarboro --Isabel hsekpr r 794 Kingston rd — J trk drvr M J
Campbell Ltd h 3 Pendrith — J G emp Goodyear Tire r 30 Twentieth
(New T) — J Harold displaymn Eatons h 48, 588 Trethewey dr (Nth
Y) --Jack h 29 Jasper av (York Twp) — Jas Mrs r 600 Crawford — Jas
handymn Dept of Wks h 471 Greenwood av --Jas B pressmn Lawr as
on -Doughty h 70 West Lynn avenue — Jas C barr Lever Bros h 81
Oriole rd --Jas E slsmn Eatons h 398 Kingswood rd --Jas G emp
Goodyear Tire h 30 Twentieth (New T) --Jas G engnr h 282
Woodfield rd --Jas H roofer h 24 Mackle m av — Jas J night watchmn
Wilson Ginger Ale h 11 Wellesley av --Jas M aircraft elect A V Roe h
162 Church (Wstn) — Jean suprvsr Children’s Aid h 68 Crescent rd
Alphabetical, White Page 373 DUNLOP --Jessie (wid Thos) h 46
Hollydene rd (Scar) — Jessie elk United Cigar Stores h 200 Concord
av — Jessie Mrs office elk Eatons r 59 Lee av — Jessie L (wid Wm) h
70 Balmoral av --Joan sec CGE r 65 Brookside av (York Twp) — John
r 180 Clonmore dr (Scar) --John comps MacLean Hunter h 182 St
Clements avenue — John stores suprvsr Brunswick Balke r 35 Fern
av — John mgr Crankshaft Specialty Serice r 180 Clonmore dr (Scar)
- John paper mkr h 62 The Lindens s s Bain av — John roofer h 24
Macklem av — John shpr Can Wire Cable h 121 Withrow av --John
stores suprvsr Brunswick -Balke -Collender r 35 Fern av — John B h
24 Copeland av — John B vehiclemn C P Exp r 634 Milverton blvd —
John C pntr & dec 24 Copeland av r same — John D insp TTC h 23
Sunnylea av w (Etob) — John E cattle buyer Swifts h 65 Sellers av --
John H plant mgr Wix Accessories Corp h 94 Binswood av (EY) —
John P off mgr h 47 Strath av (Etob) — John R stkpr CNR h 26
Kimbourae av — John S constable O Div Hdqtrs RCMP r 136 Beverley
— Jos H display Eatons h 48, 588 Trethewey dr (Nth Y) — Josephine
Mrs nurse h 1, 225 Heath w (York Twp) — Josephine M stenog Bank
of Com h 24 Dunblalne av (Nth Y) — Joyce M typist Lumberman’s
Ins Co r 178 Cosbum av (EY) --Kathleen (wid Harry) h 44 The
Maples s s Bain avenue — Laurence R emp C W Mack r 104
McRoberts av --Lawrence R (Broadview House) r 2090 Danforth a
venue — Lloyd h 10 Portland — Mabel (wid Thos) h 202 Davenport
rd — Mabel bkpr h 24 Dunblaine av (Nth Y) — Mabel emp Eatons r
701 Dupont --Mabel E elk Eatons r 228 Geoffrey —Malcolm assenbly
suprvsr Christies Bread h 65 Brookside av (York Twp) — Margt r 4
Dault rd (Scar) --Margt dom r 44 Glenayr rd (Fst H) --Margt nurse
Tor East Genl Hosp r 9 Harris av — Margt nurse St Michael’s Hosp h
294 Robert — Marie Mrs slsldy Renee Shoppe r 8, 1989 Yonge —
Marion R tchr Bd of Educ h 3, 6 Farnham av — Mary (wid Findley) r
50 Sultana av (Nth Y) — Mary emp Sunnybrook Hosp r 37 Rose Park
dr — Mary R emp Eatons h 194 Indian rd - -Maye (wid Frank) h 75
Golfview av — Moffatt D h 31 Forest Hill rd — Murray W brazer Trane
Co res Lakeview — Myrtle H hsekpr r 228 Geoffrey — Nancy Mrs
with Student Christian Movement r 494A Summerhill av --Nathan S r
30 Fairholme av w (Nth Y) --Olive Mrs ftr Dom Watch Case h 208
Roxton rd — Orville R artist A ikin -McCracken r 1 St Andrews
(Centre Is) — Patk h 41 Ravina cres — Peter emp Telegram r 5,
2673 Bloor w — R Albt r 45 Pearson av --Regd J office mgr Candn
Natl Last for the Blind h 14, 353A Danforth av — Richd C dentist 746
Bayview av h 303 Dawlish av (.Nth Y) — Richd G r 10 Berl av (Etob)
— Richd J staty engnr Colgate-Palmolive h 2 Donside dr (Scar) —
Robt h 28, 2 Glen Elm av — Robt r 354 Glebeholme blvd --Robt h 52
Park blvd (Long B) — Robt with Imp Oil h 40 St Ives cres '--Robt
constr wkr h 167 Argyle — Robt emp Conti Can r 18 Fifteenth (New
T) --Robt harbor police h 73 Robbins\av --Robt lab Wilson’s Ginger
Ale r 11 Wellesley av — Robt B co-ordinator Imp Oil r 40 St Ives cres
--Robt B dentist 746 Bayview av res York Mills — Robt E elk Sun Ins
h 51 Durant av (EY) — Robt G h 126 Burnaby blvd — Robt J sec -
treas Natl Refining Co Ltd h 65 Rose Park dr —Robt S h 203
Glencairn av — Robt W patrol officer Tor Harbour Police r 73 Robbins
av — Ronald mach h 82 Constance — Ronald mach h 101 Dupont —
Ross mech Garage Equipment r 11 Wellesley av — Ross E calculator
Federated Mutual res Wexford — Roy B acct CGE h 38 Melrose av --
Sarah r 41 Ravina cres --Shirley emp Ronson Lighter Co r 117
Regent (York Twp) --Shirley tech elk A V Roe r 162 Church (Wstn) —
Sybil stenog A E Wilson & Co r 182 St Clements avenue — T
Lawrence r 101 Strathallan blvd — Thos elk Robinson & Heath r 772
Sammon av (EY) --Thos mech Tor City Police h 779 Windermere av
(York Twp) --Thos C asst medical officer Mnfrs Life h 146 Armour
blvd (Nth Y) --Thos O h 42 Barker av (EY) — Tire & Rubber Goods
Co Ltd J P Anderson pres & g€nl mgr Geo F Plummer sec -treas
rubber tires & goods 870 Queen e --Tire & Rubber Co Ltd C T Snidal
mgr tire & sporting goods div 496 Queen e — Tire & Rubber Goods
Co Ltd E Gordon Skirrow adv mgr advt dept 468 Queen e - -Tire &
Rubber Co parking lot 297 Logan av — Vida M Mrs emp Goodyear
Tire r 54 Fifteenth (New T) — Virginia pekr E S & A Robinson r 33
Thursfield cres (Leas) --Warren M plater Snap-on Tools r 354
Glebeholme blvd --Wesley A dept mgr Crown Trust h 4, 2512 Bloor w
(Swan) — Wilfred real est agency 354 Glebeholme blvd h same --
Wm h 555 Indian rd — Wm r 91 Neville Park blvd — Wm h 2 Secord
av (EY) —Wm emp Bell Tel h 380 St Clements av — Wm lab h 25
Oliver (Etob) --Wm D nightwatchmn Ont Hydro r 24 Earlscourt
avenue — Wm E h 404 Concord av
DUN DUNLOP DUNLOP — Wm F opr h 12 Eastdale av (EY)
— Wm H foremn Milnes Coal h 701 Dupont — Wm J acct Fair grieve
& Son h 329 Monarch Park av (EY) — Wm J bldg servicemn Bell Tel
h 294 Jones av DUNLOP WM J HON, Minister of Education
Parliament Buildings, Queens Park, h 1 Elmsthorpe Avenue Phone
HUdson 9-4870 — Wm R lab Dept St Clng r 472 Old Weston rd --Wm
W h 288 Indian rd — Wm W elk United Ch Pub House h 21 Cliveden
av (Etob) — Wilma r 877 Manning av DUNLOP'S LIMITED, F M
Dunlop President, Florists, 14 Temperance Street, Phone EMpire 3-
7404 Dunmall Florence (wid Albt) r 1163 Ossington av — Maurice M
claim mgr Provident Life & Accident Ins Co h 1163 Ossington av —
Robt bodymn Evans Motors res Pickering — Ronald h 339 Lumsden
av (EY) Dunmore John maint Wm Neilsons Ltd h 36 St Clarens av
Dunn A D asst pts supt Candn Line Materials h 22 Scarboro Hghts
blvd (Scar) — Abraham h 121 Braemar av — Ada (wid John) h 16,
145 Arlington av (York Twp) --Agnes (wid Geo J) h 116 Gowan av
(EY) — Agnes (wid Francis) h 3 Muir av — Agnes chkr Simpsons h
620 GlenGrove av w (Nth Y) — Aileen C suprvsr Howell Forwarding r
41 St Clair av e --Albt mech Dunhams Machine Shop r 1, 482
Roncesvalles av --Albt E r 43 Melville av — Albt H mach C A Dunham
Ltd h 8 Chryessa av (York Twp) — Albt J PBX repairmn Bell Tel h 62
Warland av (EY) --Albt R lessee Shell Oil Co Service Stn h 374
Mortimer av (EY) --Alex blrmkr J Inglis h 180 Pacific av — Alex
calendar man Gutta Percha h 57 Rosemeade av (Etob) — Alex
watchmn Dept St Clng h 612 St Clarens av — Alex C emp Alliance
Tool & Motor Co h 16 Andrews avenue — Alex F cost elk Woman's
Bakery r 135 Bellefair a venue — Alex J trk drvr h 192 Major —
Alfred G asst suprvsr Bank of N S h 36 Poyntz av (Willowdale) —
Alfred M pres & mng dir Candn Wirebound Boxes Ltd h 25
Elderwood dr (Fst H) — Alice r 530 Church — Allan r 102 Burlingame
rd (Etob) — Allen r 5, 1268 King w — Andrew h 1270A Danforth av
— Andrew dairymn Donlands Dairy h 186 Roslin av — Andrew hide
insp McNeillie & Co res Port Credit —Andrew h 1270A Danforth av —
Andrew pattern dsgnr h 212, 4 Latimer av —Andrew tnsmth r 185
Essex — Andrew B bldg supt Eagle Star Ins h 297 Lumsden av (EY)
— Ann Mrs ward aide Tor Western Hosp h 234-2 Lippincott — £nnie
Mrs shpr Sunn Cloth r 235 Parliament — Annie B wrapper Candn
Kodak r 29 Royaleigh av (Etob) — Arnold r 84 Hook av — Arnold
emp Westinghouse h 22 Putney rd (Etob) — Arthur r 695-97 Spadina
av — A rthur carp h 640 Windermere av — Arthur time study mn A V
Roe r 44 Frances av (Etob) — Arthur B elk C P Exp r 115 Chatsworth
dr — Arthur J with Bell Tel r 30 Centre av — Arthur J phv 183 St
Clair av w h 20 Rumsey rd (Leas) — Arthur S slsmn r 39 Oakmount
rd — Aubrey F A barber Rosehill Barber Shop res Richmond Hill —
Audrey J personnel elk Personnel Dept City of Tor r 10 Westminster
av — Audrey R sec A T Whitehead QC r 52 College view Hts —
Augustine r 295 Jarvis — Austin A stk elk Candn Kodak h 9
Somerville av (York Twp) — Barbara sec Personal Finance r 20
Gerrard e — Barbara A typist X -Ray & Radium Industries r 17 The
Wishbone (Nth Y) — Beatrice (wid Jos) r 6 Blakley av (York Twp) —
Beatrice (wid Wm S) h 106 Pearson av — Ben h 468 Silverthom av
(York Twp) — Bernard mldr CGE h 93 Frizzell av — Bernard R h 3
Harshaw av (York Twp) — Bernard T r 37 Station rd (Mim) —
Bernice A stenog Zurrich has r 212, 4 Latimer avenue — Bertha Mrs
practical nurse Hillcrest Convalescent Hosp r 47 Austin ter — Bette
stenog Atlas Asbestos Co r (rear) 167 Sherboume — Bruce A insp
Ont Hydro h 59 Royalavon cres (Etob) — C Mrs plastic assembler
Percy Hermant Ltd r 1212 Davenport rd — CD bkpr Gair Co h 22,
2393 Queen e — C Geo rep Stand Life Assce res Ajax — C H slsmn
Cochrane -Dunlop Hdwre r 1391 Bloor w — Carlton pekr Stedman
Bros r 478i Brock av — Carole sis girl Reitman’s r 87 Roxborough e
— Catherine r 38 Earl — Catherine M r 259 Wellesley e --Catherine r
176 Hillside av (Mim) — Cecil E slsmn Geo E Schnier h 376 Deloraine
av (Nth Y) — Cecilia M elk Pyrene Mfg r 21 FrizzeU av — Chas r 10
Poucher — Chas btehr Swifts Candn h 599 Royal York rd s (Etob) —
Chas C watchmn Gas Co h 166 Hamilton --Chas J genl supt
Simpsons -Sears h 84 Golfdale road --Chas L h 38 Gough av — Chas
S drvr Hollinger Bus Lines h 71 F rater av (EY) — Chas W lecturer U
of T h 119 CoUier — Charlotte h 628 Duplex av — Christina (wid Jas)
h 10 Newman av (EY) --Christine Mrs graphic card fnshr Rolph -Clark
Stone r 85 Twenty-second (New T) DUNN — Christopher attdt British
Amer Oil Serv Stn r 1867 Gerrard e — Clara (wid Wm F) h 11
Eastbourne cres (Mim) — Clara (wid John) r 14 1A Howard Park av -
-Clara (wid Jerome) r 41 Queen Mary’s dr (Etob) — Clara (wid David)
sorter Scythes & Co h 885 Lansdowne av — Clara A cash United Ch
Pub House r 492 Brock avenue — Clara H Mrs h 285 Sherboume --
Clarence hi Dr Rosco Metal h 22 Melville av --Clarence W h 387
Clendenan av --Clarke H emp Cochrane -Dunlop Hdwre h 1391 Bloor
w — Cleaners & Dyers (Gordon Katz & Sam Geller) 519 Dundas w --
Clifford civil engnr CNR h 8 Glen Davis --Clifford C carp Simpsons h
15 Mountnoel av --Clifford J drvr Colville Co h 101 Lesmount av (EY)
— Clifford J auto press Consolidated Press r 101 Lesmount av (EY)
— Clifford S chief drftsmn CNR r 8 Glen Davis —Colen E bottle
washer Rexall Drug h 145 Boston avenue — Cora Mrs prsr r 1, 2215
Dundas w --Craig E r 85 Buttonwood av (York Twp) — D suprvsr
John Innis Comm Centre --D Nona Mrs sec Edison, Aird & Berlis r
211 Greenwood av — Danl emp Toronto Hydro r 21 Rose av — Danl
assembler Trane Co h 33, 1798 Eglinton av w (York Twp) — D’Arcy J
order elk CGE h 59 Medford av (Scar) — David emp Frigidaire r 790A
CoUege - -David emp Star r 885 Lansdowne av — David mgr W H
Martin (Can) Ltd h 2, 300 The Kingsway (Etob) — David night
watchmn Swifts h 99 Emerson av — David slsmn Sami Lebo — David
slsmn h 119 Braemar av — David S hrdrsr h 723 Woodbine av —
Delphine (wid John) h 115C, 321 Bloor w — Dennis P opr TTC h 123
Rockwell av — Donald emp Simpsons h 25, 814 Broadview av --
Donald slsmn Photo Engravers r 90 Castle Knock road — Donald
service man Addressograph Multi h 147 Cadoma av (EY) --Dora r
1525 Mt Pleasant rd — Doreen r 90 Castle Knock rd — Doreen emp
Boyd & Boyd r 468 Silverthom av (York Twp) — Doris key -punch opr
Ont Hosp Assn Blue Cross r 620 Glen Grove av w --Doris E plastic
press opr Minneapolis -Honeywell r 2B, 304 Bathurst — Dorothy M
Mrs elk Bank of Mont r 2843 Keele (Downsview) --Douglas perm
force h 89 Rose av --Duncan emp Can Packers h 176 Hillside av
(Mim) --Duncan emp A V Roe h 32 Westleigh cres (Etob) — Earl
control opr CFRB r 60 Atlas av (York Twp) — Earl drvr Weston
Biscuits r 4 Westport av — Edith M stenog F Hyde (Ont) Ltd res
Brampton — Edna A r 116 Gowan av (EY) — Edwd r 54 Hillsdale av
w — Edwd (Shamrock Grill) r 370 Main n (Wstn) — Edwd assembler
Underwood Ltd r 105 Flora dr (Scar) — Edwd emp Bishop’s Asphalt
& Papers r 47 McGee — Edwd C insp Pol Dept h Ellesmere rd (Scar)
— Edwd C in charge Police Training Schl — Edwd H broadcaster CBC
r 275 Bingham av --Edwd J (Vi eston Hotel) h 370 Main n (Wstn) —
Edwd M tchr Lord Dufferin Pub Schl h 28 South gate (Nth Y) —
Edwin L paper ctr W J Gage h 870 Palmerston av --Eleanor Mrs
assorter Crown Cork & Seal res Pickering — Elizth editor & adv mgr
Toronto Magazine r 52 Grandview av (Newtonbrook) — Elizth M tchr
Queen Victoria Schl r 34 High (Etob) — Elmer elk Seager Hardware h
23 Exeter —Elmer J foremn United Steel h 156 Hillside av (Mim) —
Elsie Mrs elk A V Roe r 53 Hatherley rd (York Twp) —Elsie G priv sec
Bank of Mont r 870 Palmerston av —Elva barr h 41 Queen Mary’s dr
(Etob) — Elwood C tel Can Press h 256 Queensdale av (EY) — Emily
M elk Natl Emp Serv r 218 Dunn av —Ernest with Manchester Paper
Co h 80 Thirtysixth (Long B) — Ernest brehr Loblaws r 153 Pacific av
— Ernest E engnr Can Packers h 168 Winnett av (York Twp) —
Ernest W (Dunn -Turner & Co) h 181 Blythwood rd —Eugene lab h
107 Atlee av (Scar) — F Gwenneth nurse VON r 34 High (Etob) --
Florence Mrs caretkr Eatons r 53 Wellesley e --Florence Mrs emp
Silks h 7 Rideau av — Florence M elk Candn Ice Mach r 84 Bellefair
av --Florence M priv sec Anaconda Amer Brass h 37, 1465 King w —
Florence V nurse Kings Grove Rest Home r 2, 2939 Bloor (Etob) —
Frances priv sec Blake, Anglin, Osier & Cassels r 507, 89
Breadalbane --Francis B opr TTC h 102 Lankin blvd (EY) --Francis M
carton mach opr Colgate-Palmolive h 11 Milverton blvd --Frank emp
A V Roe h 31 Jerome — Frank fruit slsmn Ont Produce h 10
Redmount rd (Nth Y) — Frank genl help Eatons r 166 Hamilton —
Frank ins slsmn h 8 High Park gdns — Frank mgr Best Yeast Ltd r
190 Chambers av — Frank B messr Bank of Tor h 56 Hickson av --
Fred G mech CNR h 106 Pearson av --Fred S mining engnr h 247 St
Clements av — Fred T firemn New Toronto Mun h 72 Second (New
Toronto) —Fredk maint Mimico Pumping Station h 91 Twelfth (New
T) --Fredk orderly Chorley Park Hosp r 553 Parliam ent --Fredk C tax
coll York Twp h 38 Royal (York Twp) — Fredk J slsmn Gas Co r 117{
Pape av — Fredk W p c New Toronto Pol Dept r 28 Thirtieth (Long B)
— G J industrial sis mgr F P Weaver Coal h 13 Cedar Grove blvd
(Oakville) — Geo r 25 Frances av (Etob) — Geo r 84 Hook av — Geo
asst mgr Plant Maintenance Equip r 22 Oakdale —Geo emp Doctor
Ballard’s Dog Food h 498 King e --Geo ferry opr Airports Div Tor
Harbour Commn h 26 Steirier — Geo lab TTC r 302 Milverton blvd —
Geo slsmn Acme Farmers h 74 Rose av --Geo A insp York 'f'wp Hydro
h 18 Montye av (York Twp) — Geo A constable North York Police
Dept h 494 Brookdale av (Nth Y) — Geo C W boat bldr J J Taylor h
10 First (New T) --Geo H lab Dept St Clng h A, 2989 Dundas w _ —
374DUNN — Geo J plmbr Bd of Educ h 4, 1 MacKay av — Geo S
(Dunn’s Insurance Service) r 67 Old Colony rd (York Mills) — Geo T
cond CPR r 7, 2952 Dundas w — Geo W plate room asst Gair Co r 28
Omagh av (Wstn) — Georgina Mrs h 85 Buttonwood av (York Twp)
— Georgina off elk Eatons r 172 Davenport rd — Gerald druggist h
56 High Park blvd --Gertrude (wid Odey) h 26 Lappin av — Gladys H
emp Candn Red Cross r 18 Montye av (York Twp) — Gloria D typist
Gas Co r 31 Jerome — Gordon pntr r 285 Sherboume — Gordon A
office mgr United Church of Canada Dept of Pensions h 492 Brock av
— Gordon H prof engnr Ont Hydro r 18 Montye av (York Twp) —
Gordon W emp TTC h 302 Milverton blvd — Grace Mrs opr Eatons h
668 Huron — Grace D playground suprvsr Parks & recreation Dept h
218W, 118 Montgomery av — Gwendolyn emp Paton & Baldwins r
468 Silverthom av (York Twp) — Gwenneth nurse VON r 34 High
(Etob) — Gwynneth Mrs h 19 Balmuto — Harold elk Lorie Ltd h 21
Harvie av — Harold elk Dom Stores r 86 Hel endale av --Harold E
office work Laurie Ltd r 21 Harvie av — Harold J engnr John Inglis h
723 Woodbine av — Harold J pres &gnel mgr Therm-O-Rite Products
Ltd h 103 Manor rd e —Harold J whol parts rep Genl Motors
Products r 209 Sixth (New T) --Harry genl hlpr Browns’ Bread r 302
Milverton blvd — Harry A block mkr A Florry & Son h 41 Norval (York
Twp) --Harry K slsmn Candn Engnmg Publications h D6, Bexhill Ct
(Etob) — Helen Mrs h 48 Highfield rd --Helen wtrs h 19, 197
Wellesley e — Helen M h 45, 342 Avenue rd — Helen M E Mrs bkpr J
E Grasett & Co r 37 Tenth (New T) — Horace emp Artmetal
Enterprise h 10 Bicknell av (York Twp) — Howard L sis suprvsr
Candn Liquid Air h 4, 1472 Avenue rd n (Nth Y) --Hugh h 32 & J3'4,
356 Bloor e — Ieleen r 610 Pape av — Inez r 48 DeLisle av --Irene L
elk Bell Tel r 31 Shaver av (Etob) — Isabell key punch opr Inti Bus
Mach r 35 Swan wick avenue — Isabella Mrs h 727 Annette —
Isabella Mrs r 16 Kingscourt dr (Etob) — Isabella Mrs stenog
Nortown Motors r 1, 185 Sheridan av — Isobel nurse r 10, 325
Tweedsmuir av (York Twp) --Isobel nurse aid Christie Bisc r 178
Marion — J Clarence h 132 Fairview av — J Obrdon h 37 Station rd
(Mim) — Jack h 235 Parliament --Jack sis Junction Hardware &
Automotive h 129 Day av —Jack C adjuster Eatons h 310 Bedford
Park av (Nth Y) — Jacquelie r 9 Ward --Jas h 1262 Lansdowne av —
Jas h 1, 75 Oriole gdns — Jas elect Candn Comstock h 85 Dorset rd
(Scar) — Jas sheet metal wkr Trailmobile h 48 Balfour av — Jas
tnsmth h 36 Eastgate cres (Scar) --Jas A opr Cindn Kodak h 33
Renfield (Nth Y) — Jas A slsmn Independent Elect r 117 Paton rd --
Jas C mgr Swifts h 338 Royal York rd n (Etob) — Jas E editor Press
News Ltd h 349 Kennedy rd (Scar) — Jas E emp English & Mould h
117 Paton rd --Jas G chief tracing elk CPR h 39 Kings Garden rd
(Etob) — Jas J 2nd chef Royal Candn Military Inst h 21 Frizzell av —
Jas M mgr Dept of Const & Maint Brewers Warehousing h 38 St
Andrews gdns — Jas R opr TTC r 1337 Lansdowne av — Jean R r 45
Oriole gdns --J erry elk Sheffield Bronze Powder r 234 Coleridge
avenue —Jessie r 159 Pape av — Jessie (wid Jas) h 25 Frances av
(Etob) — Joan nurse St Michael’s Hosp h 78 Rosemount av — Joan
Mrs receptionist Aubrey J Boyd r 2393 Queen east — John h 12
Bumhamthorpe cres (Etob) — John h 168 Sixth (New T) — John h
73 Earl Grey rd --John h 32 Thirtieth (Long B) — John opr asst
Colgate-Palmolive h 53 ShudeU av — John emp Moffats r 127
Harding av (Wstn) --John mech Hogan Pontiac Buick r 85 Homewood
avenue --John Jr tile setter r 73 Earl Grey rd --John A cr elk Rosco
Metal h 48 Kipling av n (Etob) --John A pekr Genl Steel Wares r 286
Broadview avenue — John C emp Compensation Hosp Milton h 619
Gladstone av --John F elk J F Hartz Co h 673 Huron — John J (Dunn
& Franko) h 346 Islington av (Etob) --John J elk Bank of Mont h
1480 Applewood rd (Port Credit) — John J emp Lever Bros h 286
Broadview av --John J foremn Northern Electric h 22 Elsfield rd
(Etob) --John J slsmn Timken Roller Bearing r 15 Dundura cres (York
Twp) —John N elk CNR h 106 Pacific av --John Newton barr & sol
1409, 330 Bay r 123 Sheldrake blvd — John P emp Jones Transport r
19, 197 Wellesley --John P shipping elk Ont Rubber Co r 1255
Dufferin --John Playgrounds before 337, cor Ossington av & Harrison
—John R elect engnr CGE h 1, 46 Leacrest rd (EY) --John R pressmn
Warwick Bros h 84 Bellefair av —John W with Bell Tel h 77 Arundel
av — John W Jr emp Gordon McKay r 16, 145 Arlington av (York
Twp) --John W slsmn A S May & Co h 149 Brentwood rd (Etob) —
Jos h 45 Enderbyrd —June elk A V Roe r 620Glen Grove av w (Nth Y)
— K slsmn Eatons r 78 Morgan av --Kathleen Mrs h 610 Pape av --
Kathleen elk Humberview Motors h 36 Royalavon cres (Etob) —
Kenneth C elk Can Trust r 300 HoUywood av (Nth Y) --Kenneth K wtr
Brunswick Hotel h 234 '"’oleridge av (EY) — Kevin roofer r 161
Concord av --Kevin J fitter group suprvsr John T Hepburn Ltd h '35
Glenlake av — Laura elk Eatons r 23 Palmerston sq DUNN --Laura B
Mrs office sec Ont Federation oi & School Assn Inc h 115 Cheritan av
— Lawrence emp Ont Automobile h 13 Alhar --Lenore stenog G M
Henry r 117 Paton rd — Leo leather wkr Eatons r 508 Ontario —
Leonard tool mkr Phinn Co h 637 Durie (' Twp) — Leonard J mach
Anaconda Amer Brass r (New T) --Leonard W emp Can Wire & Cable
h 302 ] ton blvd --Leslie servicemn Pitney -Bowes of Can r Pape av
— Leta h 281 George --Lewis h 158 Fairview av --Lewis S slsmn CCM
h 1 Halifax pi (Burlb — Lillian emp Moffats r 17 The Wishbone (I --
Lily M h 73 Warren rd — Lloyd bkpr Smith -Corona h 33 Fairmount —
Lloyd J elk CNR r 141 Glendora — Lois S priv sec Imp Oil r 7
Thomcliffe a1 —Lome emp Bailantyne h 246 Sixth (New T —
Lorraine r 54 Lavinia av (Swan) — Louis color mkr Ault & Wiborg r
158 Fii — Louis J counter slsmn Candn Westinghou: r 139 Emerson
av --Louise Mrs h 2. 165 Admiral rd --Louise E tchr Our Lady of
Peace Schl r ] Bumhamthorpe cres (Etob) — Mabel A h 4 Twenty -
second (New T) --Maitland h 2340 Dufferin (York Twp) - -Margt h 14
Parkview av — Margt r 53 Wellesley e — Margt r 53 Wellesley e —
Margt Mrs h 349 Kingston rd — Margt bkpr Margaret Pennell
Advertising Momingside av (Swan) — Margt hsekpr r 236 Inglewood
dr --Margt social wkr Children’s Aid r 71 Qu< , Park cres — Margt E
(wid Jas) h 15 Scarth rd --Margt E bkpr Cassidy’s r 22 Logan av n --
Margt R A Mrs toll billing elk Bel Tel r na av (EY) --Marie elk CNR r 48
Delisle av --Marion head of dept Eatons h 54 Hillsdah --Marjorie (wid
Geo) h 95 Gamble av (EY) --Marjorie (wid Jas) r 10 Glencrest blvd (I
— Marjorie r 41 Queen Mary’s dr (Etob) --Marjorie emp CGE r 628
Christie — Martin emp Can Elect r 73 Earl Grey rd --Mary (wid David)
r 90 Castle Knock rd --Mary (wid Danl) h 790A College — Mary (wid
Geo) r 84 Hook av --Mary (wid Robt) h 48 Pine av --Mary (wid Robt)
h 123 Sheldrake blvd --Mary (wid W W ) r 174 Sherwood av — Mary
Mrs wtrs r 20 Spadina rd --Mary A Mrs h 90 Farnham av --Mary A r
885 Lansdowne av — Mary I (wid Robt) h 37 Tenth (New T) --Mary
R tchr St Josephs High Schl r 11 Ei bourne cres (Mim) --Maude (wid
Wm) h 1, 482 Roncesvalles a --Maude E E r 8 Chryessa av (York
Twp) --Maudie (wid M Albt) h 230 Annette --Maurice welder Candn
Laundry Machine 527 Dufferin --May (wid Alfred) h 1, 302 Kingsway
s (Su — Memorial Pres Church Rev Fredk G Ves 2 Twenty- sixth
(Long B) --Michl radio techn TCA r 1514 Davenport — Mildred stenog
Kennedy & Ross r 280 Or — Mildred A (wid Benj) r 152 Westlake av
( — Minnie Mrs hsekpr r 298 RusseH Hill rd — Morris F slsmn Scales
& Roberts r 27 ^ (Wstn) — Murdock A comp Northern Miner Press
Briar Hill av (Fst H) --Muriel litho fnshr Rolph -Clark -Stone r 4
Carlton --Muriel stenog Wr C McLaughlin r 682 Co: --Myrtle A drsmkr
h 174 Sherwood av —Nettie B (wid Geo L) h 27 Pricefieid rd --Nona
Mrs priv sec r 211 Greenwood av — Norman E elect Ont Elect h 28
Benlamon --Norman E emp Bell Tel h 3, 165 Admiral --Norman M
barr & sol 1311-1313, 67 Yom Foxbar rd --Olivia M tchr Wilkie Blvd
Schl r 302, 16f Bathurst (York Twp) s Pi; ) rood --Pat with
Strathmore Press r 117 Piton --Patricia Mrs emp Imperial Bank r 839
P, — Paul J insp Phoenix r 14 Parkview av --Peter (Dunn’s Auto Tops)
r 85 Laird dr --Philip D priv sec IOF h 114 Warden av (S — Philip R
aircraft mech A V Roe h 1, 23 Y (York Twp) --Phillip H E h 27 William
(Wstn) --Raymond W mgr A E Hanna Prescription ar; cy h 407, 404
Spadina rd --Rebecca (wid John) h 680 CoxweH av --Richd C W h 60
Boultbee av — Richd G acct elk Reo Motor Co h 304C St Court (Etob)
—Rite Cleaning & Pressing (Richd Ujiye) Parliament —Robt h 34 High
(Etob) — Robt bldg supt Bank of Com h 218 Lawrer av < — Robt
emp Ditto of Can r 156 Hillside av ( n) —Robt food processor
Foodcraft Laborator 246 Dundas e — Robt maint Montreal Trust Bldg
r 52 Ea2 avenue —Robt H emp Bill Paper Co r 498 King e ; —Robt I
litho Millers r 176 Hillside av (Mi — Robt L timekpr Tor Motor Car h
205 Oss (ter: avenue — Robt M mgr Dom Bank (Queen & Augusta
Jasper av (York Twp) --Robt N r 72 Brookside av (York Twp) --Robt N
(Dunn’s Ins Service) h 109 Evelyn es --Robt W wtr Metropolitan
Hotel h 54 Davb ile avenue --Ronald shpr Higgs Paper Box h 555
Jones v — Rosemary bkpr Tax Sales Service r 21 F zei avenue --Ross
r 3, 291 St George --Ross B chief engnr Bank of Tor h 689 Or --Ross
J (McMillan, Binch, Wilkinson, Stua Berry & Dunn) h 206 Inglewood
dr —Roy A studt-at-law Fraser, Beatty, Tuck McIntosh & Stewart r
123 Sheldrake — RusseH prod hlpr Carrier Engineering h (New T) --
RusseH G mech h 9 Ward --RusseH G slsmn FuUer Foods h 20 Sandf
--RusseH V asst mgr Murray’s Rest h 59 I lav sdal« — Ruth Mrs
receptionist Warsop Power Toe r 338 Glebemount av (EY) —Ruth
stenog John Howard Society of Ont r Elm av --Sales Ltd Harry B
Perkins mgr mfg agt 2nd fir, 146 Jarvis — Sami mech DeHaviUand h
1041 Greenwoo — Stanley caretkr McCoomb Publishing h 4? & Pk
Ltd
anlev M mech engnr Plewes Jackson Engineering h 621
Windermere av ophen mgr Karry’s Billiard Academy h (rear) *167
Sherburne , _ san (wid Wm) r 43 Gledhill av (EY) Jas stmftr
Universal Plumbing & Heating h 271 Sammon av (EY) *d firemn New
Toronto Fire Hall r 72 Second fttfew T) , _ . teresa r 15 Dundurn cres
( fork Twp) leresa F stenog Comp Bd r 14, Parkview av elk Osier,
Hammond & Nanton Ltd r 370 Sunnyside av ios drvr Hollinger Bus
Lines h 71 Frater av os emp John Inglis h 12 Ralston av (EY) ’umer
& Co (Ernest W Dunn & E Clayton Turner) accts & auditors 579 St
Clair av w lerie priv sec Presbyterian Women’s Miss Soc h 10
Glencrest blvd (EY) ra stenog CNR h 202, 131 Dunn av ra M stenog
Natl Adhesives (Can) r 578 Willard av mon P (Green & Dunn) r 73
Earl Grey rd ctor r 117 Madison av ctor C city firemn h Lot 63 Tower
dr (Scar) .lor R D auditor Confed Life r 19 Alcina av ocent A mach
fixer Herbert Hosiery h 55, 1638 Queen e pharmacist h 407, 404
Spadina rd — Fred h 32, 1 Mallory gdns ,.i.Tas wrehsemn Jas
McKenzie & Co r 12 Seaton --[John photo Etched Name Plates h 38B
Lyall av — Iter contr r 179 Concord av ..[iter mach Massey-Harris h
28 Criscoe (York ! Twp) -■[iter A mach opr Anchor Cap res RE #3
Pickering -Liter J*h 23 Elmsdaie rd (EY) ..lsley J dentist 2nd fir, 2781
Yonge h 13 Heme Hill (Etob) _ Lsley N opr TTC h 578 Willard av
(York Twp) —lsley W emp Canada Metal h 139 Bleecker --fcstlev
porter Can Perm port h 225 Sherboume --jlfrea L off elk Massey -
Harris r 28 Criscoe (York Twp) lfrid W mannequin mkr Bingham
Display r 8 Chryessa av (York Twp) hard R serv foremn Puddicombe
Motors h 351 Osier av a r 132 Shuter a btehr Plumstead Products r
10 Newman av • i chemist Aul craft Paints h 128 Anthony rd (Nth Y)
elk CandnGirl Guides r 1270 Danforth av conciliation officer Dept of
Lab (Ont) h 404 Merton elect welder h 93 Eastwood av (Scar) emp
Goodyear Tire r 10 Westminster av engnr Bradshaw’s r 711 St
Qarens av ldgrkjbr Can Packers h 6 BXakley av (York maint man
Enuretone Co h 17 The Wishbone (Nth Y) mech engnr Ventures Ltd
h 37 Ridge dr opr TTC h TO Westminster av receiver Crown Cork &
Seal h 526 Cedarvaie av (EY) staty engnr U of- T h 133 Oak Park av
(EY) A r 285 Sherbourne A mach Candn Acme Screw 8s Gear k 100
Helena av A toolmkr Conti Can h 175 Monarch Park av *■’ » A C
emp Natl Emp Serv r 88 Durm av F with Watt & Watt h 125
Wildwood cres F div elk TTC h 13 Maple blvd (New T) H (Dunn’s
insurance Service) h 5 GosweH rd (Etob) •*'iH letter carrier P O h 2
Qstend av (Swan) -*’l J acct Lowe Bros h 136A King (Wstn) i. J loco
firemn CNR h 73 Nor din av (Etob) ~'i J sismn Weston Auto Supplies
h- 129 Day av — 1 1 l btehr Plumsteads r 10 Newman av (EY) "h R
carp h 48 Birch av -h R sismn Minnesota Mining h 34, 84 Willow av -
-’ma mgrss Women’s Bakery h 72 Parkview Hills cres (EY) --'nan drvr
Eatons h 26 Momingside av (Swan) -! ialey (Norman Dunn & Gordon
Daley) solicitors 1311-13, 67 Yonge — Franko (John Dunn & Mac
Franko) real est 98 Main n {Wstn) — Levack Ltd Thos P McConvey
pres Thos R Chapman vice -pres J Arnold Murray sectreas livestock
dlrs 1st fir, 3, 590 Keele Di ’s Auto Tops (Peter Dunn) 3 Balliol ’■ ai (C
Yemon Priestley) coal yard 8s office 205 Ninth (New T) urance
Service (Wm H & Geo 8 & Robt N Dunn) ins 1st Hr, 6 Wrellington e
— irxnacy (Leon Baker) 484 Roneesvalles av *- lnrs (Sydney
Weingarten) 948 Bloor w and 2274 Bloor w, 548 Danforth av, 747
Lake Shore rd (New T), 1474 Queen w, 1070 St Clair av w, 1 222 St
Clair av w Ouadge Lucy A (wid Wm) h 144 Hoaland av 0u m Ella R r
47 Seaforth av '■ji h 65 Twenty-sixth (Long B) *Che see also Dun
and Dunn ' ■■drew emp Battersby Sheet Metal Works r 185 Essex -
file (wid J R) r 106 Kimbark blvd (Nth Y) — Justus G wat damn h 7
Lamb av rbara with Tor Genl Trusts r 1126/. CoHege — oil M sis mgr
Wm H Dunne Skate Co h 53 Elmwood av — vd r 81 Wiileoeks — vd J
sr insp Bom Elect Protection h 69 Lavender rd (York Twp) :ie H Mrs
stenog Tor Family Court h 81 Somerset av — mk drvr Tor Peterboro
Trans h 145A Lansdowne av rjgnr Bank of Mont r 268 Manor rd e i M
factory supt W H Dunne Skate Co h 41 Marmaduke 2 ’.old radio
techn Eatons h 274 Millwood rd "!aa Mrs h 34 Lyall av ner F stock
trader Dom Securities Corp res Streetsville • ward milk sismn Olive
Farm Dairy h 238 _ . Robina av (York Twp) jX emp Acme Dairy r 84
Kane av (York Twp) K acct traffic mgr Simpsons h 108 Kipling av n
(Etob) (Dunne’s Lock & Key Service) h 1126^ College " m watchmn
Customs Bldg r 288 Carlton -•
DUP DUPONT DUPONT --Harold body repairmn Eatons h
720 Woodbine av — Hodgson Gold Mines Ltd Sami Taylor sec 1024,
85 Richmond w — Jeannine field organizer Junior Red Cross Candn
Red Cross Soc h 8, 2269 Queen e --Ladies Wear (Christine Louis)
1548 Dupont — Maurice lab C P Exp r 7, 805 Bloor w — Pat
bartender Childs of Can r 720 Woodbine av — Peter H orderly Home
for Incurable Children r 278 Bloor e --Pharmacy (Jos Tromstein) 653
Dupont — Service Station & Garage (Wm E Widner) 828 Dupont —
Shoe Shine (Steve Rousakos) 1612 Dupont — Textiles Ltd J H
Douglas pres Walter Lawson sec-treas textiles & woollen piece goods
533-5 College --Valet The (Jos Bryant) clnrs & dyers 649 Dupont
Dupper Franciscus J clnr CPR r 65 Hewitt av Dupras Clement r 566
North cliff e blvd (York Twp) — Edgar bodymn Leaside Auto Body h
182 Hopedale av (EY) Duprat Frank Q cash Silverwoods r 41
Osborne av Dupre Adolphus carp r 374 Ontario — Anna emp Ont
Hydro r 2, 1187 Avenue rd n — Gordon emp Delbodkin Motors h 27
Thirty -fifth (Long B) --Leon emp Candn Arsenal h 10 Foch av (Etob)
— Margt Mrs mach opr Bouvier Envelopes r 312 Ranee av (Nth Y) —
PhiliD H welder Plate & Structural Steel h Park rd (Nth Y) Dupree
Thos C h 1193 Dovercourt rd Dupres Edgar body man Leaside Auto
Body & Refinishers Ltd r 182 Hopedale av (EY) Duprey Alphonse trk
drvr h 183 Grenadier rd — Rita typist Jas Robertson Co r 87 Crescent
rd Dupuis A Fred emp Can Packers h 373 Sunnyside av — Alfred r 67
Twenty -sixth (Long B) — /ristide emp Can Packers r 475 Brock av —
Arthur mach r 206 Carmichael av (Nth Y) — Bernard R staty engnr
Pilkington Glass h 13 Walter — Chas emp Carrier Shoes r 655 Bloor
w --Clayton elk Crescent Building Products h 3 Thirteenth (New T) —
Elizth W (Glenora Sweets) h 16 Jesmond av (York Twp) — Ernest
collector B & M Readers h 185 Cowan av — Fred with Fred’s Steak
Service h 416B Euclid av --Garland insulator Jar dine Kings way Co h
267 Torrens av (EY) — Geo emp Maloney Electric r 120 Seventh
(New T) --H lab W & A Gilbey r 67 Twenty -sixth (Long B) — H Jos
drvr Hill the Mover h 655 Bloor w — Herman engnr Woman’s Bakery
h 642 Eastern av --Inez E Dckr Christie Brown r 115 Gladstone av —
Jean Mrs sec Hydro Elect r 247 Pacific av --John shovel opr Heslop
Homes Ltd h 172 Sheldon av (Etob) --John R A emp Toronto
Telegram r 183 Logan av --Jos stkpr Amalgamated Elect n 32 Bartlett
av --Jos A emp Century Cleaners h 4, 2 Cumberland — Jos A
wrehsemn CNR r 475 Eller slie av (Willow dale) --Laurence h 226
Bingham av — Leo h 278 Jarvis — Leo suprvsr Goodyear Tire h 35
Priscilla av (York Twp) — Liliane dom r 19 Alexandra Wood (Nth Y)
— Loretta A assembler Inti Bus Mach r 286 Gerrard — Nelson laster
J D Carrier Shoe r 655 Bloor w --Norman emp Shamrock Plastering h
198 Grenadier road --Olive Mrs r 32 Bartlett av — Pearl Mrs sec Bloor
Hotel h 481 Spadina rd (Fst H) --Philip slsmn Roadway Equipment Co
h 78 Lavinia av (Swan) —Pierre phy Sick Children’s Hosp h 271
Snowdon av —Ross lab Massey -Harris r 817 Shaw --Theresa Indry
wkr St Michael’s Hosp r 168 Jarvis Dupuix Florence r 49 River
Duquemin Sidney gdnr h 44 Fulton av Duquesnay Frances L mach
opr Acme Carbon & • Ribbon h. 126 Alcornav —Olgahrdrsr Yonge
Bloor Hairdressing Parlors r 126 Alcorn av --Ruby Mrs elk Sparton of
Can h 20 Lynd av — Violet h 126 Alcorn av Duquett Adrian wtr h 118
Hazelton av Duquette Geo acct Central Mining Services Ltd h 322
Rumsey rd (Leas) — Germaine r 211 Withrow av —Napoleon h 687
Cosbum av (EY) --Wilfred welder h 18 Scott rd (York Twp) Dura
Coats Ltd Allen Digman pres H S Davison genl mgr 1355 Duffer in —
Geo watchmn r 1, 2 Atlas av Durabilt Wall Products Co (M W
Fichman & John Soyka) tileboard 345 Sorauren av Durable Battery
(Raymond R Coates) battery serv 956 Yonge — Building 646
Adelaide w — Cafeteria Irving Israel mgr basement 460 Richmond w
— Corporation Ltd Harold Rosen mgr elect stoves & appliances 3
McMurray av — Electric Appliance Co (Walter A Clark & Fred J
House) 81 Jarvis --Furniture (Jack Teachman) 1107 Weston rd (York
Twp) — Hat & Cap Co (Louis Weisbrod & Sami Lastman) 779 Queen
w — Shoe Repair (Allen Astri) 1544 Bloor w --Upholstered Furniture
Co (Max Winer) 1331 St Clair av w Durachinski Frank Jr emp CPR
Wrehse r 201 Euclid av --Frank lab North & Peckman Co h 201 Euclid
av — Jos studt r 201 Euclid av Durack Helen pres A-One Answer
Service r 3, 93 Mallory cres (EY) Durance Christine Mrs elk Dom
Oxygen r 436 Mortimer av (EY) —Cyril emp Alcan h 26 Forty -first
(Long B) --Doris emp Petch Cleaners Ltd r 28 Forty -first (Long B) --
Ernest W foremn Arrow -Hart & Hegeman h 263 Beresford av — Geo
S emp A V Roe h 48 Batavia av (York Twp) --Gladys Mrs nurse r 304,
62-64 St Clair av w —Insurance Service (John J & Wm R Durance &
Larry S Evans) ins agts 2nd fir, 700 Bay — Irene emp Arrow-Hart &
Hegeman r 28 Fortyfirst (Long B) --John J (Durance Insurance
Service) h 63 St Clair av w --Percy R foremn Arrow -Hart & Hegeman
h 14 Villa rd (Lone B) — W R & Associates Ltd A E Williams pres M
Lennox vice -pres Insurance adjusters 6th fir, 54 Wellington w —
Wm E h 710 Lansdowne av DURANCE — Wm R (Durance Insurance
Service) h 73 Summer hill av ♦Durand see also Durrant — Basil emp
W H Dunne Skate Co r 694 St Clarens avenue — Beatrice M (wid
Clarence) matron Andrew Mercer Reformatory h 723 Shaw --Chas
drvr Eatons h 200 Hamilton — Chas E h 52 Elmsthorpe av (Fst H) --
Christie drvr Lyons Furniture h 75 Jasper av (York Twp) --E compt
opr H M Barnett Co r 531 St Clarens av — E B Miss h 38 St Germain
av --Edwd H buffer Birks h 694 St Clarens av — Elizth (wid Armand)
typist Ont Motor League h 153A Westminster av --Grace (wid Ernest)
h 104, 463 Gerrard e --Gwen Mrs tchr Humbercrest schl h 5, 1529
Bathurst (York Twp) --Helen (wid Egbert) r 885 Dovercourt rd --
Jacqueline h 278 Jarvis — Jas emp Allens Const Co h 180 Lamtton
av (York Twp) — Jas R emp Parlt Bldgs h 57 Fernwood Park av —
Jean r 694 St Clarens av — Jessie h 38 St Germain av — John trk
drvr Inter-City Forwarders h 200 Hamilton — John G glass engraver
Pilkington’s r 104-463 Gerrard e --Jos emp Swansea Constn h3
Humber blvd (York Twp) — Paul r 37 Jameson av Duranovich Geo
const h 192A Seaton Durant Carl D pres Aerocide Dispensers Ltd h
75 Clivedon av (Etob) — Edith Mrs r 20 Burnham rd (EY) — Ellis r 61
Sorauren av — Eunice Mrs r 531 St Clarens av --Geo P slsmn Wilkins
Smallwares h 697 Rhodes avenue — Jas G mng dir Simms Motor
Units of Canada Ltd h 271 St Clements av — Jas H mach Durabilt h
20 Hanley (York Twp) — John emu Frieldaire h 88 Merton — John
motor mech York Town Motors h (rear) 623 St Clarens av —June K
microfilm opr Imp Oil h 1, 1454 Avenue rd n (Nth Y) — Kathleen E h
7, 1946 Queen w --Lee h 121 Robert — Lewis K elk Can Life res
Markham — Lizzie M (wid Geo R) h 141 Castlefield av — Merton
slsmn Can Life Assce Co h 217 Hillhurst blvd (Nth Y) — Norman shpr
Powerlite Devices r 187 Delaware avenue — Norman supt Lyons Real
Estate h 29 Mutual — Robt emp Adams Furniture h 135 Shuter —
Ross elk Can Bank of Com r 217 Hillhurst blvd (Nh Y) — Walter r 244
Dupont Durante Secundo h 741 Palmerston av Duras J h 105, 98
Vaughan rd (York Twp) — Jos r 58 Humbert Duratile Tileboard Ltd
John Soyka and Morris W Fichman vice -pres tileboard 345 Sorauren
av Durban John A elk Imp Oil h 63 Ben Machree dr (Port Credit)
Durbano Danl emp Reid Transp h 82 Robinson — Donald S slsmn
Shortill & Hodgkins Ltd r 576 Balliol — FranK trkr Ziegelstiens h 39
Stayner av (Nth Y) — Harry contr h 238 Euclid av — Jas fruit & veg
858 Dundas w h' 12 Robert — John ml dr Tor Fndry h 39 HaAey av
(York Twp) --Jos lab Durbano Construction h 7 Huron --Marguerite
factory wkr Prest-O-Lite r 39 Haney av (York Twp) --Nick constr wkr
Durbano Construction h 558 Victoria Park av — Sami slsmn Ray
Hook Real Estate h 494 Ossington avenue --Wm barber Classee
Barber Shop h 576 Balliol Durber Frank emp Premier Cutlery h 7,
1504 King w — Frank shpr Vic Mathewson Co r 1485 King w —Maxie
emp S B Adams & Co r 127 Isabella Durbin Carl art dir Alford R
Poyntz h 41 Scarborough Beach blvd — Credit Jewellers Ltd Louis E
Durbin pres 273 Yonge --David (Eze-Fit Co) h 20 Kirkland blvd (Nth
Y) — David optometrist Durbin Credit Jewellers Ltd r 18 Wembley rd
(Fst H) --Donald R acct E W Hickeson & Co h 81 York View dr (Etqp)
— Fredk elev opr Monarch Belting h 103 Clovelly av (York Twp) —
Herbt H supt Claude Apts h 107, 1 Claude av —Kenneth (Comer
Snack Bar) r 323 Wychwood av (York Twp) — Louis E pres Durbin
Credit Jeweller Ltd h 18 Wembley rd (Fst H) --Nathan optometrist
Durbin Credit Jewellers Ltd h 37 Camberwell rd (York Twp) — Sami
pntr & dec 74 Sussex av h same Durcan Thos lab Dept of Wks h 229
Wellesley e Durda Antoni lab McColl-Frontenac r 46 Grove av —
Michl emp Massey -Harris h 1447A Dundas w — Tony h 28 Roxton rd
— Wilhelmina W typist C P Exp r 1447A Dundas w Durdin Fredk M
elk Employers’ Liability Assce r 189 Dupont — Marilyn staff nurse
VON r 36 St Andrews gdns Durdle Alex carp Adams Furniture h 54
Rosevear av (EY) — Jack shpr r 159 Waverley rd —Norman emp CGE
h 592 Palmerston av Durdy Geo W supt St Jams s Cemetery h 635
Parliament — Roslyn A sec Planning Dept (Ont) r 635 Parliament —
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