LITMIR.BIZ

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the 1800s and dominated the history of psychiatry until the late 1900s? Were they inevitable? Inexorable? Unstoppable?

      There can be no doubt about the need for some kind of solution to the urgent problems presented by the destitute mentally ill in eighteenth-century Ireland.181 No sooner had a House of Industry been opened in North Brunswick Street in Dublin in 1773, for example, than it needed to deal with an extraordinary influx of destitute persons with mental disorder.182 In 1776, 10 cells were specifically dedicated for the mentally ill; in 1778, an entire extra house was taken over for persons with mental disorder; in 1798, 32 additional cells were required; and 10 years later, 4 more cells were added. Between 1799 and 1802, some 3,679 persons died in this House of Industry, many of them mentally ill.

      Nationwide, the Houses of Industry, by 1804, contained disturbingly large numbers of persons with mental disorder or intellectual disability, including 118 in the Dublin House of Industry, 90 in Cork, and 25 in Waterford.183 Conditions in the Limerick House of Industry were particularly brutal, with one 1806 report indicating that mentally ill persons were kept naked, chained, handcuffed and exposed to the elements.184 More specifically, John Carr, in The Stranger in Ireland, described disturbing scenes of mistreatment, neglect and cruelty in the Limerick establishment, which he visited in 1805:

      Under the roof of this house, I saw madmen stark naked girded only by their irons, standing in the rain, in an open court, attended by women, their cells upon the ground-floor, scantily supplied with straw, damp, and ill-secured. In the wards of labour, abandoned prostitutes, in rags and vermin, each loaded with a long chain and heavy log, working only when the eye of the superintending officer was upon them, are associated throughout the day with respectable old female housekeepers, who, having no children to support them, to prevent famishing, seek this wretched asylum. At night, they sleep together in the same room; the sick (unless in very extreme cases) and the healthy, the good and the bad, all crowded together. In the venereal ward, the wretched female sufferers were imploring for a little more covering, whilst several idiots, squatted in corners, half naked, half famished, pale and hollow-eyed, with a ghastly grin, bent a vacant stare upon the loathsome scene, and consummated its horror. Fronting this ward, across a yard, in a large room, nearly thirty feet long, a raving maniac, instead of being strapped to his bed, was handcuffed to a stone of 300lbs [136 kilograms] weight, which, with the most horrible yells, by a convulsive effort of strength, he dragged from one end of the room to the other, constantly exposed to the exasperating view and conversation of those who were in the yard. I have been well informed that large sums of money have been raised in every county for the erection of mad-houses: how has this money been applied?185

      Clearly, despite the Inspector General of Prisons having the power, since 1787, to inspect all places where the mentally ill and intellectually disabled were kept,186 there were still real problems with conditions of confinement. Walsh summarises the position:

      By the closing decades of the 18th century lunacy had become a problem not only for families of property but also for those responsible for maintaining civil order. The first action was taken against lunatics who were vagrants, beggars or thieves. These were sent off to bridewells or jails and left to languish there often until they died. Their general state and condition was subject to the scrutiny of the Inspectors of Prisons, a role which had been created around 1770. Prisons were plentiful in Ireland and no town with any pretensions towards importance lacked one. With the coming of the 19th century, public lunacy became a social problem of some magnitude.187

      Against this rather bleak background, it was increasingly clear that the twin problems of destitution and mental illness in nineteenth-century Ireland needed to be addressed both urgently and systematically. But what, precisely, was to be done?

      Looking at the management of mental disorder in particular, Battie, in his 1758 Treatise on Madness, set out clear views that while mental illness was still poorly understood,188 it was clear that asylums were absolutely essential for both the treatment of patients and the education of physicians.189 Battie had particular views about the causes of ‘madness’,190 chiefly related to the brain, and emphatically recommended confinement in asylums, ideally far distant from the patient’s home, with spectators banished from the buildings along with any other persons that might excite the patients and impede recovery.191 This regime would bring considerable benefits, according to Battie, who also warned against confining the mentally ill in prisons or regarding them as public nuisances: mental illness was, in his view, both manageable and curable.192

      In addition to confinement, Battie dutifully devoted attention to the roles of specific treatments in the management of the mentally ill, such as bleeding, opium, mineral waters and vomiting.193 But the chief argument in his Treatise on Madness concerned asylums, which he felt should be places of treatment rather than simple confinement, and where conditions should be hygienic, therapeutic and markedly different to those prevailing in prisons.

      Battie was a leading figure of his time, a fellow of the Royal College of Physicians in London and physician at St Luke’s Hospital, and his views were highly influential. Shorter goes as far as to argue that the birth of psychiatry commenced in earnest with Battie.194 Given his strong promotion of asylums, his broad professional influence, the clear social problems presented by the mentally ill, and the philanthropic impulses of the governing classes of the 1800s, the die was soon very firmly cast in the form recommended by Battie: the 1800s were to be the century of the asylum.

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      THE NINETEENTH CENTURY:

      GROWTH OF THE ASYLUMS

      … it is of the utmost importance that cases of insanity should as speedily as possible be removed to an asylum.

      Lunatic Asylums, Ireland, Commission, Report of

      the Commissioners of Inquiry into the State of the

      Lunatic Asylums and Other Institutions for the

      Custody and Treatment of the Insane in Ireland:

      with Minutes of Evidence and Appendices (1858)1

      For the mentally ill, the tone of the turbulent nineteenth century was set firmly by the Criminal Lunatics Act 1800, implemented following the attempted assassination of King George III at the Drury Lane Theatre, London in May 1800 by James Hadfield, a dragoon suffering from mental disorder and, possibly, brain injury.2 The legislation established a procedure for the indefinite detention of mentally ill offenders and led to state funding of accommodation for apparent criminal lunatics at Bethlem in London.

      In Ireland, the Hospitals and Infirmaries (Ireland) Act 1806 enabled Grand Juries to present money for wards for lunatics in connection with County Infirmaries and for the maintenance of asylums in connection with the Houses of Industry.3 There was still enormous pressure on the House of Industry in Dublin and in 1810 monies were made available for the building of a public asylum, named the Richmond Asylum, in honour of the Duke of Richmond, Lord Lieutenant of Ireland. The establishment was later known as the Richmond District Lunatic Asylum (from 1830), then as Grangegorman Mental Hospital and, from 1958, as St Brendan’s Hospital.

      In the early days of the Richmond, Dr Alexander Jackson (1767–1848), a physician at the House of Industry, had an especially keen interest in the mentally ill, having visited asylums abroad and provided advice on the new Richmond building.4 The architect was Francis Johnston, whose other work includes Dublin General Post Office, and the asylum was built on a plan similar to that of Bethlem. The first patients from the House of Industry were transferred in 1814 and the Richmond was officially opened the following year, when an act was passed establishing its governors as a corporation with perpetual succession.5

      The new Richmond Asylum, with Jackson and Hugh Ferguson as physicians, and Andrew Jackson as surgeon, was determined to provide enlightened care to the mentally ill and avoid the use of physical restraint wherever possible. Initial reports were duly positive, noting that no more than one patient in twenty was confined to his or her room, and in most of those cases the reason for confinement was physical illness rather than disturbance due to mental disorder.6 In the early 1830s, the Richmond Asylum, valued with its furniture

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