Hearing Voices - Brendan Kelly

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opinions that Swift developed mental illness, based on the views of Samuel Johnson, William Makepeace Thackeray and Sir Walter Scott, among others.55 The idea that Swift became a lunatic gained considerable currency following his death, along with the belief that Swift had, in later life, become a patient at the very hospital he founded. In 1849, Dr (later Sir) William Wilde (1815–1876), an eye and ear surgeon, and distinguished author on the subjects of medicine, folklore and archaeology, wrote an entire book about Swift’s health and recounted that it was rumoured that Swift was the first patient at St Patrick’s, although this was not true.56

      These tales about Swift had their roots not only in contemporary gossip and innuendo, but also in the fact that, in 1742, a writ, de Lunatico Inquirendo, was issued, declaring Swift ‘a person of unsound mind and memory, and not capable of taking care of his person or fortune’.57 This writ was issued following a petition from Swift’s friends and consideration of medical evidence, and the declaration made by a jury.

      Notwithstanding this writ, it is clear that Swift was not truly mentally ill: a lunacy enquiry was the only legal means by which a person incapable of conducting their own business affairs or looking after themselves could be effectively protected.58 As a result, the writ did not necessarily mean that Swift had become a ‘lunatic’, but simply that he was no longer in a position to manage his own affairs and required assistance, most likely as a result of age-related decline. In fact, Swift lived just three years after these events, largely in isolation, and did not write during these later years.

      With regard to the specifics of Swift’s health and possible diagnoses, there were suggestions that Swift may have been afflicted with a form of syphilis,59 but it now appears clear that Ménière’s Disease was most likely the central diagnosis.60 Ménière’s Disease is a disorder of the inner ear that affects hearing and balance, and symptoms include vertigo, tinnitus and hearing loss. Various medical examinations of Swift’s life have concluded that he experienced giddiness, nausea, dizziness and tinnitus, all of which are consistent with Ménière’s Disease, especially from the 1730s onwards. In 1736, Swift complained explicitly about some of these symptoms to his friend Alexander Pope, noting that he could no longer write, read or think clearly because of them.61

      Swift also experienced severe memory loss from 1739 onward and may have suffered from cerebrovascular disease (impaired blood supply to the brain), further reducing his abilities and cognitive function. Sir Russell Brain (1895–1966), a British neurologist, was of the view that this was the root cause of Swift’s symptoms in later life, especially his aphasia (impairment of language).62 Ultimately, a great number of opinions have been expressed about Swift’s health and the emergent consensus appears to be that he suffered from Ménière’s Disease during his life and cerebrovascular disease towards the end, possibly contributing significantly to his death.63

      It is beyond doubt, however, that, towards the end of his life, Swift did not recognise people familiar to him and lost the ability to express himself.64 This must have been an extraordinary frustration for a man so accustomed to thinking, writing and speaking with outstanding passion, clarity and, in relation to the mentally ill, charity.

      St Patrick’s Hospital, Dublin:

      ‘Swift’s Hospital’

      Following Swift’s bequest and his death in 1745, on 8 August 1746 a royal charter was granted to St Patrick’s by King George II (1683–1760) and St Patrick’s became the first psychiatric hospital in Ireland, and one of the first in the world.65

      On 29 August 1746, the board of governors held its first meeting and the first patients, four women, were admitted on 26 September 1757, at which point the hospital had just sixteen admissions rooms.66 They were joined by five male patients in early October.67 The hospital expanded significantly over the following decades and admitted growing numbers of patients, although reports from the early 1800s indicated difficulties providing treatments and concern about lengths of stay.68

      Such concerns were by no means unique to St Patrick’s and, in March 1817, Robert Peel, Chief Secretary, persuaded the House of Commons to set up a select committee to look into the need to make greater provision for ‘the lunatic poor in Ireland’.69 The committee considered all such establishments, including St Patrick’s, and concluded that ‘the extent of the accommodation which may be afforded by the present establishments in the several counties of Ireland’ was ‘totally inadequate for the reception of the lunatic poor’.70

      During the course of its deliberations, the committee received a letter from ‘Mr James Cleghorn’, ‘medical attendant’ at ‘Saint Patrick’s or Swift’s Hospital’, dated 17 March 1817, with interesting information about the hospital.71 Cleghorn pointed out that recent years had seen ‘very considerable improvements’ at St Patrick’s, which, by that time, housed 96 ‘paupers’ and 53 ‘boarders’.72 Cleghorn was ‘fully aware of the advantages to be derived from dividing the different description of insane persons into classes, according to the nature and stage of the disease’, but noted that ‘the original construction of Swift’s Hospital does not admit of their separation, as it consists of six very long corridors or galleries, each containing twenty-eight cells’.

      Cleghorn ‘was very anxious to have some separate cells for the noisiest of the patients, built apart from the principal building’ but the government did not grant money for this development, citing the ‘great accommodation for the insane, which the Richmond Lunatic Hospital would afford, which was then in progress’.73 Cleghorn regretted the government’s decision:

      … the reasonableness of enabling us to adopt the system of classification in the most material point would have ensured to us more extensive aid; medical treatment in maniacal persons, and the insane in general, except in the very early stages of the disease, has ever appeared to me to be of little service towards the cure of it … moral treatment, as it is called, is of much more moment than medical, and I am sure that in this particular, much improvement has taken place of late years; and that the late investigations will contribute much to the amelioration of the state of lunatics.74

      Cleghorn was at pains to point out the infrequent use of restraint at St Patrick’s:

      The system observed in Swift’s Hospital, before I was concerned in it, was of the most humane kind; and it has always been my object to avoid any other coercion or restraint but what was required for the safety of the patients and those around them. The strait waistcoat and handcuffs are seldom resorted to, and we prefer the latter to the former, as being more convenient for cleanliness, and not so heating; occasional confinement to the cell is the principal restraint which we employ.75

      Cleghorn reported, with satisfaction, that he had ‘succeeded, last spring, in prevailing on the governors to take a lease of the ground on the east side of the hospital, containing two acres and a half, and affording a good view into the Phoenix Park, where the greater number of the patients are at liberty to walk about and to take exercise’. Many were also ‘employed, with their own consent, in working the ground, and have been much happier and freer from their malady in consequence of it’.

      Cleghorn also addressed distressing allegations regarding transport of mentally ill persons to Dublin from elsewhere in Ireland:

      I wish, while writing to you on this subject, to take notice of certain statements which I have seen in the public prints, as having been lately made in the House of Commons, relative to the conveyance of mad persons to Dublin from the country. It has been said, that they have been tied to cars, and so bruised as to render the amputation of their limbs necessary, and that death has ensued from the mortification occasioned by this cruel mode of conveyance, During fourteen years I have attended Swift’s Hospital, I have never known an instance of the kind where any ill consequences have followed.76

      Cleghorn heard ‘it rumoured, that it is intended to have either provincial or county asylums for lunatics and idiots: such a design is founded in wisdom and humanity, and will be a great relief to the pressure on the establishments in the capital’. This rumour was correct and, having taken account of the evidence of Cleghorn and others, the 1817 Committee duly recommended that ‘there should be four or five district asylums capable of containing each from one hundred and twenty to one hundred and fifty lunatics’.77

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