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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
The 1845 Act also permitted the Lord Lieutenant to direct ‘that any person who might be detained in custody in any gaol by virtue of any such warrant as aforesaid should be removed to the [local] lunatic asylum [and] remain under confinement … until it should be duly certified to the said lord lieutenant, by two physicians or surgeons, or a surgeon and physician, that such person had become of sound mind’.180 Convicts who were certified insane could also be removed to the new asylum and then returned to prison or discharged (as appropriate) if medically certified as now being of sound mind.181
The 1845 Act was also notable for making provision for one or two suitably qualified persons to act as Inspectors of Lunatics in Ireland, to take over relevant duties from the Inspectors General of Prisons.182 In 1846, the first person appointed to this position was Dr Francis White (1787–1859), a remarkable physician who had opened a hospital and anatomical school on Ormond Quay earlier in his career and had been an Inspector General of Prisons since 1841.183 A second inspector, Dr John Nugent, was appointed in 1846, having previously served as travelling physician to Daniel O’Connell (1775–1847), an Irish political leader.184 Nugent had no experience managing the mentally ill and there were various complaints about his performance.185 The inspectors’ first report appeared in July 1846 and Nugent was later knighted by the Lord Lieutenant.186
The other historic outcome from the 1845 Act was the establishment of the Central Criminal Lunatic Asylum in Dundrum, Dublin, which was erected relatively swiftly at a cost of £19,547.187 Individuals were admitted if they were charged with an offence in court and deemed insane at trial or developed symptoms of mental illness while in prison. The asylum opened for admissions in 1850 and by 1853 there were 69 male and 40 female inpatients.
Patients admitted to the Central Criminal Lunatic Asylum generally presented complex combinations of psychiatric, medical and social need, often including poverty.188 For example, 70 women were admitted between 1868 and 1908, most of whom were Roman Catholic and single, with an average age of 33 years.189 Over half were charged with or convicted of killing, mostly child killing.190 Almost one woman in 10 was declared ‘sane’ on admission, but might have seemed mentally ill at the time of offence or trial. Among the others, ‘mania’ and ‘melancholia’ were the most common diagnoses. Approximately 15 per cent of these women died at the asylum; almost 50 per cent were eventually transferred to local asylums; 12 per cent were transferred to prison; and others were released to family or friends.
Between 1910 and 1948, a further 42 women were admitted, a majority of whom were detained ‘at the Lord Lieutenant’s pleasure’ (i.e. indefinitely).191 The most common diagnoses were ‘mania’ or ‘delusional insanity’ (38 per cent) and ‘melancholia’ (24 per cent); 7 per cent were ‘sane’. The average duration of detention was almost six years, after which 28 per cent were transferred to district asylums and the remainder released under various different circumstances.192 Overall, the average length of stay for women charged with infanticide or the murder of their child between 1850 and 2000 was 9.3 years, although it ranged from three months to 38 years.193
There was a complex mix of social, psychiatric and medical problems in evidence among both male and female patients, including mental disorders ranging from ‘mania’ to folie à plusieurs (when several people share delusions or fixed, false beliefs),194 various issues relating to intellectual disability,195 and physical illnesses such as syphilis196 and tuberculosis.197 Given this complicated combination of factors, it is unsurprising that there were substantial changes in admission practices over time as rates of admission fluctuated, and the use of ‘fitness to plead’ procedures in the courts varied significantly, peaking during the period from 1910 to 1920.198
Recurring issues at the Central Criminal Lunatic Asylum included the overcrowding that was so widespread throughout the asylum system during the 1800s and early 1900s;199 the tangled relationship between gender and the insanity defence;200 and the troubling matter of persons who were committed to the asylum but appeared sane by the time they actually arrived there.201 These issues – and many others – were readily apparent throughout the asylum system in general as early as the mid-1850s, when they elicited a by now familiar response from the authorities: the establishment of yet another commission of inquiry and the production of yet another report. But first, however, in 1854, the 1851 Census of Ireland led to the emergence of a fascinating Report on the Status of Disease which presented important, formative information about the mentally ill and intellectually disabled in Ireland.
The 1851 Census of Ireland and
a ‘Report on the Status of Disease’
The Census of Ireland performed in 1851 provided a wealth of fascinating data and reasons for continued concern regarding mental disorder in Ireland. A Report on the Status of Disease, based on the census and co-authored by Dr William Wilde, who was knighted in 1864 owing in large part to his work on the census, was published in 1854.202 Wilde’s biographer, Dr T.G. Wilson, wrote that he was especially fascinated by the statistical side of the census, which complemented Wilde’s work with individual patients and gave him a broader view of population health.203
The Report concluded that there were 5,074 ‘Lunatics’ and 4,906 ‘Idiots’ in Ireland, and that ‘many individuals in both these classes were also affected with epilepsy’.204 This meant that ‘there was 1 Lunatic in every 1,201 inhabitants, and 1 Idiot in every 1,336 of the population of the entire country’:
In the provinces, the proportions of both classes to the general mass of the community are least in Connaught, being but 1 in 1,022, and greatest in Leinster, where they amount to as many as 1 in 484. The returns of the province of Connaught exhibits a remarkable immunity from both Lunacy and Idiocy. In Ulster we find a proportion of 1 in 679, and in Munster 1 in 729. It would appear that Lunatics prevail most in the cities, but this arises in part from Asylums being located therein, many of the inmates belonging to which could not, from want of proper information on the subject, be distributed according to their native places. Among the counties, the greatest number of Lunatics, in proportion to their populations, were to be found in Dublin, Wexford, Carlow, Westmeath, and Kildare. Idiocy was found to prevail most in Louth, Kildare, Wexford, Monaghan, and Cavan. Both classes taken together prevailed most in the counties of Wexford, Dublin, Kildare, Westmeath, Louth, Queen’s [Laois] and Longford. With respect to the sexes, we find among the Lunatics 100 males to 102.72 females, and of the Idiotic class 100 males to 84.02 females.205
The report went on to analyse ‘2,164 cases in which the cause of disease has been investigated, and an opinion offered thereon’.206 Proposed causes were grouped into three categories: ‘physical causes’ (44 per cent, with males outnumbering females), ‘moral causes’ (39 per cent, with females outnumbering males) and ‘hereditary taint or family predisposition’ (17 per cent, with females again outnumbering males). ‘Physical causes’ included ‘congenital disease’ (‘specified as malformation of head, and composed chiefly of Idiots’), ‘intemperance’, ‘epilepsy’, ‘disease of the brain’, ‘paralysis’, ‘fever’, ‘injuries of head’, ‘puerperal mania’, ‘the effects of climate, including sunstrokes’, ‘disease of the brain’ (owing to ‘cerebral affection’), ‘mercury’, ‘uterine derangement’, ‘venereal excess’, ‘dyspepsia’, ‘rape and seduction’, and ‘violent hysteria’. ‘Moral causes’ included ‘grief’, ‘reverse of fortune’, ‘love and jealousy’, ‘terror’, ‘religious excitement’, ‘study’, ‘anger or excessive passion’, ‘ill-treatment’, ‘anxiety’, ‘pride and ambition’, ‘political excitement’, ‘music’, and ‘remorse’.
In some cases, information was provided on specific diagnoses:
Among the insane, Mania was the form of disease manifested in about four-fifths of the whole: of these 669 instances were induced by moral, and 400 by physical causes, while 222 were attributed to hereditary taint. In 44 cases the Mania was of a suicidal character, grief and