Hearing Voices - Brendan Kelly

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1). The Cork arrangement was not, in Rice’s view, a solid basis for establishing a broader system of asylums; dedicated, systematic, legislative reform was needed at national level.

      The situation in Cork contrasted sharply with that in Waterford, where Rice reported there were ‘a few miserable cells attached to the House of Industry, resembling an ill-constructed gaol rather than a retreat for lunatics’.29 In Clonmel, ‘so little understood was the management of the insane that they were unable even to keep them clothed, and some were lying in the yard upon straw in a state of nakedness’.30

      Matters were worse again at the ‘Lunatic Asylum of Limerick, in which the accommodation afforded to the insane’ was ‘such as we should not appropriate for our dog-kennels’. There was no heating or ventilation, and the mentally ill were ‘exposed during the whole of the winter to the extremities of the weather’, resulting in amputations (owing to ‘that mortification in the extremities, to which the insane are peculiarly liable’) and deaths (owing ‘to the extreme coldness of the situation’):

      … two, and sometimes, I believe, three of the insane have been condemned to lie together in one of those cells, the dimensions of which are six feet by ten feet seven inches; some of them in a state of furious insanity. In order to protect them from the obvious results, the usual mode of restraint was by passing their hands under their knees, fastening them with manacles, fastening bolts about their ankles, and passing a chain over all, and then fastening them to a bed. I can assure the Committee, from my own knowledge, they have continued for years, and the result has been (and I believe an honourable friend of mine may also have witnessed the fact) that they have so far lost the use of their limbs, that they are utterly incapable of rising.31

      Other parts of the Limerick establishment were designated for the physically ‘sick, as well as for such insane as may be trusted at large without actual danger’:

      In one of these rooms I found four-and-twenty individuals lying, some old, some infirm, one or two dying, some insane, and in the centre of the room was left a corpse of one who died a few hours before. Another instance was still stronger: in the adjoining room I found a woman with the corpse of her child, left upon her knees for two days; it was almost in a state of putridity. I need not say the woman was almost in a state of distraction; another was so ill that she could not leave her bed; and in this establishment, with governors ex officio, and with all the parade of inspection and control, there was not to be found one attendant who would perform the common duties of humanity.32

      To compound matters, Rice reported that during a period of ‘fever’, ‘all medical attendance had been discontinued’ and prescriptions were issued from ‘a mile and quarter distance’. In addition to poor conditions and neglect, there was also evidence of active abuse, as ‘the keeper of the lunatics claimed an exclusive dominion over the females confided to his charge, and which he exercised in the most abominable manner; I decline going into the instances, the character of which are most atrocious’. While Rice reported that, since these events, there had been changes in personal and practice at the Limerick establishment (on the advice of ‘Dr Hallaran in Cork’), the committee was clearly still deeply impressed by Rice’s compelling evidence.

      Against this background, the committee, in its conclusions, had no doubt but that a properly governed network of district asylums was needed in order to remedy the plight of the destitute mentally ill, an issue which was, they noted, ‘so materially importing the character of the country, and so deeply interesting to humanity’:

      Your Committee have observed with satisfaction, the disinterested labours of those who have superintended the Asylums in the cities of Dublin and Cork; and if they were to go into any detail of the principles on which the establishments which they propose might be best administered, they would earnestly recommend an entire conformity to the system laid down and acted on in the Richmond Lunatic Asylum, as that system appears to have been considered with great anxiety and acted on with signal success.33

      John Leslie Foster, one of the governors of the Richmond Lunatic Asylum, gave evidence to the committee about the background to the Richmond’s approach and Foster’s evidence, like that of Rice outlining abuses in Limerick, shaped the committee’s thinking substantially. Foster reported:

      Until within these very few years a much greater degree of coercion has been generally applied in the treatment of lunatics, than is now found to be necessary; a few years ago Mr Pinel, a French physician [Chapter 1], who had the charge of the principal receptacles for the insane at Paris proposed and published a more gentle mode of treatment. It appears in his hands to have been attended with great success; this mode was introduced into this country, I believe, in the first instance in the Quakers Asylum near York; the good effects of which are illustrated in a publication of a Mr Took [sic],34 the manager of that asylum; and this system appearing to the governors of the Richmond Lunatic Asylum to be founded in good sense, they determined on trying the experiment in their new institution. I beg to add as a proof of this, that there is not in the Richmond Lunatic Asylum, to the best of my belief, a chain, a fetter, or a handcuff. I do not believe there is one patient out of twenty confined to his cell, and that of those who are confined to their cells, in the greater number it is owing to derangement in their bodily health, rather than to the violence of mania.35

      The stirring endorsement of the Richmond’s approach in the 1817 report led to the passage of the Asylums for Lunatic Poor (Ireland) Act 1817 which was amended by the Lunatic Asylums (Ireland) Act 1820, and both of which were then repealed by the Lunacy (Ireland) Act 1821,36 which aimed ‘to make more effectual provision for the establishment of asylums for the lunatic poor, and for the custody of insane persons charged with offences in Ireland’. More specifically, the 1821 Act stated that ‘it shall and may be lawful for the lord lieutenant by and with the advice and consent of his Majesty’s privy council in Ireland, to direct and order that any number of asylums for the lunatic poor in Ireland shall be erected and established in and for such districts in Ireland, as to the said lord lieutenant and privy council shall seem expedient’.37

      On the heels of this provision, a mere four years after the hard-hitting 1817 report, the creation of Ireland’s district asylums commenced in earnest: four district asylums were rapidly completed during the remainder of the 1820s (Armagh,38 Belfast,39 Derry and Limerick) and five more by 1835 (Ballinasloe, Carlow, Waterford, Maryborough (Portlaoise) and Clonmel).40 Together, these establishments had the capacity to accommodate 1,062 patients in all. This development was consistent (although not continuous) with the emergence of various medical hospitals supported by the professional and merchant classes in the 1700s, the establishment of further ‘voluntary’ medical hospitals in the 1830s, and widespread provision of ‘fever hospitals’, along with increased organisation of the medical profession, especially dispensary doctors, during this period.41

      All of these developments represented significant changes for the poor, the ill and the excluded in nineteenth-century Ireland: social problems were pressing; institutions were the answer; and the mentally ill were among those most desperately in need of care. The era of the asylum had well and truly arrived.

      Treatment in Asylums: ‘Education and Training

      form the Basis of the Moral Treatment’

      The establishment of Ireland’s asylums was accompanied by a significant consolidation and expansion of the roles of doctors in the treatment of the mentally ill and management of the new institutions. At the Richmond, Dr John Mollan (a native of Newry, educated in Edinburgh) was appointed as ‘physician extraordinary’ in January 1836 owing to his medical experience across various Dublin hospitals and a particular interest in the insane.42 Two years later, Mollan presented a detailed ‘statistical report on the Richmond Lunatic Asylum’ at the Evening Meeting of the Royal College of Physicians on 26 March 1838.43

      Mollan commenced his overview by emphasising that the Richmond was intended not just for the safekeeping of the insane, but for their rational treatment and cure. The Richmond was, he said, the first institution in Ireland specifically constructed for the classification of the insane, with a view to the provision of better, more appropriate care. Mollan was a strong proponent of laborious employment

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