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Hearing Voices. Brendan Kelly
Читать онлайн.Название Hearing Voices
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isbn 9781911024446
Автор произведения Brendan Kelly
Издательство Ingram
‘Cullen’ was Dr William Cullen (1710–1790), a prominent Scottish physician who had substantial influence on an entire generation of prominent asylum doctors including Hallaran, John Ferriar, Benjamin Rush and Thomas Trotter, author of A View of the Nervous Temperament.94 Cullen was the first asylum doctor to use the term ‘neurosis’ which, in contrast with later usage, he used to denote a range of psychiatric disorders that occurred in the absence of pyrexia (i.e. in the absence of raised body temperature).95 Consistent with Cullen’s approach, Hallaran’s distinction between organic (physical) and non-organic (psychological and moral) factors in causing mental disorder was to consolidate the foundation for much subsequent work on determining causes of insanity throughout the nineteenth and twentieth centuries.
Syphilis, for example, was cited as a major cause of admission to psychiatric institutions throughout nineteenth-century Europe,96 despite the fact that accurate diagnosis was not possible prior to the work of August Paul von Wassermann (1866–1925), the German bacteriologist who developed a complement fixation test for syphilis in 1906.97 Nevertheless, Hallaran undertook to gather the first systematic data on the causes of psychiatric admissions in Ireland, and identified, as best he could, that venereal disease accounted for a lower proportion of admissions in Ireland than elsewhere.98
Towards the end of the nineteenth century, several decades after Hallaran’s textbook appeared, the classification of mental disorders underwent further revision as Emil Kraepelin (1856–1926), a German psychiatrist, divided all mental disorders into 13 groups, including two groups of ‘functional psychosis’ (i.e. mental disorders involving a loss of contact with reality but without demonstrable organic or physical cause).99 These two groups were: affective psychosis (in which loss of contact with reality was accompanied by disturbance of mood) and non-affective psychosis (in which it was not).
Kraepelin’s classification, like Hallaran’s approach, recognised the key role of organic or physical factors in producing certain cases of mental disorder, but went a step further by dividing ‘functional psychosis’ into these two separate groups. This classification duly led to the emergence of ‘manic depression’ (bipolar disorder, sometimes involving psychosis with prominent mood disturbance) and ‘dementia preacox’ (schizophrenia, or psychosis without prominent mood disturbance) as substantive diagnostic entities which are broadly still retained in current classification systems.100 The distinction between organic and functional disorders, as emphasised by both Hallaran and Kraepelin, is also retained in diagnostic and clinical practices some two centuries after Hallaran’s text first appeared.
Unsurprisingly, Hallaran was, like virtually all of his peers, deeply concerned with ‘the extraordinary increase of insanity in Ireland’, which he, characteristically, attributed to both ‘corporeal’ (i.e. bodily) and ‘mental excitement’,101 and which he also related to the effects of social unrest,102 ‘terror from religious enthusiasm’,103 and ‘the unrestrained use and abuse of ardent spirits’,104 among other factors. Unlike many of his peers, however, Hallaran brought a great deal of systematic and critical thought to the treatment of mental disorders, expressing scepticism about many of the established remedies of the times and notable enthusiasm for others.
Treatments in the Late 1700s and
Early 1800s: Spin Doctors
In his 1810 textbook, Hallaran provided a careful consideration of many traditional physical treatments for mental disorder (e.g. bloodletting); a detailed exploration of novel treatments (e.g. Dr Cox’s Circulating Swing, which is explored shortly); and a re-evaluation of traditional medicinal remedies (e.g. opium) and various other approaches (e.g. shower baths, diet and exercise).105
These treatments, and Hallaran’s relatively scientific approach to them, represented a shift from older, more traditional practices which, according to Lady Jane Wilde (1821–1896), included placing the mentally ill person in a pit in the ground (three feet wide and six feet deep), with only the head uncovered, and leaving him or her alone for three days and three nights, without food or contact with anyone.106 A harrow-pin (from a harrow, an agricultural instrument) was placed over the person, owing to the alleged mystical properties of harrow-pins. If the unfortunate person survived this dreadful ordeal, it was reported that a cure might be effected, although Lady Wilde conceded that the majority of those who survived emerged from the pit cold, hungry and mentally worse than ever.
Lady Wilde also recounted folk beliefs that madness was both hereditary and caused by demonic possession, and could be cured by drinking honey, milk and salt in a seashell before sunrise.107 Other treatments included exorcism by witch doctor, which involved the local witch doctor drinking whiskey, speaking unintelligibly at some length, throwing holy water over the patient and room, hitting the patient repeatedly with a blackthorn stick (while the patient was held down), and then swirling the blackthorn stick wildly around the room hitting any people or objects it encountered.108 Particular attention was paid to hitting the door through which the demon would allegedly escape. The exorcist was comprehensively fortified with whiskey throughout this elaborate, alarming, brutal process.
It is not entirely clear when this ritual dates from, how long it persisted, or whether it occurred at all, but Lady Wilde goes on to describe a specific example which, she says, took place ‘lately’ (her book appeared in 1890).109 If Lady Wilde’s sources are to be regarded as reliable, this is a most disturbing case. It concerns a man in Roscommon who apparently became mentally ill and was bound hand and foot, foaming at the mouth. He was described as ‘elf-stricken’ as it was believed he had been replaced by a fairy demon. The witch doctor was summoned and concluded that the unfortunate man had been replaced by a horse which needed to be fed oats in order to keep the horse alive and, thus, keep the real man (now in Fairyland) alive too.
At this, the patient was forcibly fed a sheaf of oats while the exorcist and the general company sent for five kegs of poitín (poteen, a strong, distilled, alcoholic Irish beverage) to fortify themselves for the exorcism ahead. A bucket of cold water was thrown on the patient’s head and the exorcism began. In the midst of the ritual, however, the patient was untied and immediately made as if to attack the witch doctor, with the result that the witch doctor and all the others fled the house, pursued by the extremely irate patient. The patient was, however, soon overpowered and again tied up, after which a magistrate ordered that he be brought to Roscommon Lunatic Asylum, where he is said to have died.
By way of contrast with these disturbing, dramatic tales, Hallaran’s treatment techniques in Cork in the early 1800s were significantly less punitive, although they were not entirely without drama either. Turning to traditional physical treatments first, Hallaran expressed particularly little faith in venesection (bloodletting) which was a common treatment for a range of conditions, including mental illness, for many centuries.110 While acknowledging the usefulness of venesection in certain circumstances, Hallaran generally felt that ‘bleeding to any great extent does not often seem to be desirable, and except in recent cases, does not even appear to be admissible’.111 This was consistent with the views of Dr William Battie (1703–1776), influential author of Treatise on Madness, who had written in 1758 that bloodletting was positively harmful if the patient was feeble or suffering from convulsions.112
The administration of emetics, to make the patient vomit, was another common treatment for a range of disorders,113 but while Hallaran acknowledged ‘the use of emetics in all febrile affections’ (i.e. infections producing high body temperature),114 he was cautious about their use in mental disorder: ‘I have been a witness to very disagreeable consequences arising from the want of necessary precaution on this head, which have deterred me from directing full emetics in any case’. Battie was similarly circumspect about vomiting.115
Notwithstanding these views, emetics and purgatives were commonly used for a range of physical and mental disorders in Ireland and elsewhere: in 1810, the same year that Hallaran published his textbook, Dr Martin Tuomy, Fellow of the Royal College of Physicians of Ireland, produced his Treatise on the Principal Diseases of Dublin116 in which he explicitly endorsed the use of purgatives and emetics, which might be administered daily for up to 21 days. As was the case with bloodletting, these treatments were aimed at evacuating noxious ‘humours’ from the body in order to produce clinical improvement. There was, however, growing