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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
As regards ‘paying patients’, the commission noted that ‘there is no fixed rule in district asylums’ as ‘some boards decline to receive them; others receive them at a charge equal to the cost of maintenance; and in others the annual payment demanded is regulated at the discretion of the Board of Governors’:228
We are of the opinion that the admission of paying patients should be distinctly recognised, but that it should be subject to such restrictions as the Central Board, which we shall propose to establish, may lay down, both as to the class of patients and the proportion of such cases to be admitted into the asylums, so as at the same time to protect the ratepayers from undue taxation, and the lunatic poor of the lowest class from unfair encroachment upon the accommodation intended more especially for them.
The class of patients to be admitted ought not to comprise those who, from the means which they possess, should be maintained in a private asylum.229
After considering the various laws and regulations governing asylums, the commission then turned its attention to the ‘general condition of the asylums’, and found plenty of causes for concern including, inter alia, ‘cold and cheerless’ airing courts;230 ‘imperfect or ill-planned’ sewage arrangements; ‘defective’ water supplies; ‘inattention to cleanliness’; ‘privies … so offensive as to be absolutely injurious to the health of the inmates’; ‘improper occupation of inmates’; poor heating and ventilation; bedsteads ‘of bad and objectionable construction’;231 ‘neglect of school instruction’;232 misuse of restraint in certain asylums;233 and a ‘general want of’ recreation and amusement for patients:
At present, whatever attempts have been made in a few instances, and especially at Richmond and Sligo, in the way of evening entertainments, & c.,234 nothing has been done to mitigate the bare and cheerless character of the apartments usually occupied by the inmates. In corridor or day-room, the lunatic sees nothing but the one undiversified white wall – giving to these hospitals, intended for the restoration of the alienated mind, an air of blankness and desolation more calculated to fix than to remove the awful disease under which it labours.
It cannot be denied, notwithstanding the care and attention which appear generally to be given by the managers and visiting physicians to the patients under their charge, that, on the whole, the lunatic asylums of Ireland wear more the aspect of places merely for the secure detention of lunatics than of curative hospitals for the insane.235
After this rather damning consideration of district asylums, the commission next examined the position of the mentally ill in workhouses, and concluded that ‘there can be no more unsuitable place for the detention of insane persons than the ordinary lunatic wards of the union workhouses’.236 On this basis, the commission outlined a proposal ‘to appropriate unused workhouse accommodation for certain classes of insane’:
It should be competent to the Board of Governors of any asylum to direct the admission of any lunatic of the above class237 belonging to the district into the workhouse asylum; and, on the recommendation of the resident physician of the asylum, to admit directly to such workhouse asylum any such lunatic then in gaol or workhouse, or for whom admission to the district asylum may be sought. The governors should also have power to transfer patients, when necessary, from these auxiliaries to the district asylums.238
Notwithstanding its approval of ‘workhouse asylums’, the commission did not approve of the idea of ‘provincial asylums’, recommending instead that ‘as far as possible, all cases should be treated in the district asylum’.239 The commission advised clarity on the role of the Central Criminal Asylum and, specifically, that ‘a law should explicitly define who is to be detained in the criminal asylum; and as cure is not the only object with which such an institution has been founded by the state, the incurable inmate should not, because his case is hopeless, and he may himself be harmless, be again remitted to association with lunatics who are not criminal’.240 Other recommendations included establishment of a ‘central board’ to control and direct asylums;241 various changes to the establishment and conduct of ‘private asylums’242 and the role of chaplains;243 and the ‘desirableness of benevolent institutions for the insane’;244 and various other suggestions.245
Many of the commission’s conclusions were not new: it recommended expansion of the asylum system (e.g. through ‘workhouse asylums’) and strongly endorsed the idea of permanent segregation as a key element in management.246 More progressively, however, it drew attention to the importance of the asylums ‘as educational establishments, for the purpose of extending a knowledge of the nature and treatment of insanity’:247
We feel confident that, if the lunatic asylums of Ireland were made places of instruction, medical science would be improved and humanity benefited; and that the benefit would not be limited to Ireland, but that the blessing of a humane and enlightened treatment of the insane would be extended through other countries […].
We cannot doubt that, if proper exertion were made, students in medicine, or graduates who had just completed their course, would seek for appointments as residents in asylums, as the knowledge thus acquired, and the certificates they would obtain of such residence, would be esteemed recommendations in many positions in which they might afterwards be placed. We would recommend that, in the first instance, the experiment of such appointments should be made in the asylums of Dublin (St Patrick’s and the Richmond), of Cork, and of Belfast, in which towns there are large medical schools […].
Such resident pupils might be appointed by the Board of Governors, on the recommendation of the resident physician, and should be subject to his direction. Their duties would consist in keeping notes of the cases admitted, and their treatment, in seeing to the due administration of medicines, baths, & c., and in a general care of the inmates and patients in the intervals of the visits of the resident or visiting physician; in short, in discharging towards the inmates of the asylum such duties as are now performed by resident pupils towards the sick in general hospitals.248
This was an innovative, progressive proposal, aimed at improving standards of care in the longer term, and clearly in line with the commission’s other recommendations for greater medical involvement in the asylums and improved education of staff. Overall, however, the commission’s recommendations were strongly in the direction of an expanded asylum system and permanent institutionalisation for certain patients. Scant attention was paid to the possible merits of other possibilities (e.g. treatment at home),249 as the commission emphatically endorsed the fundamental tenet that ‘it is of the utmost importance that cases of insanity should as speedily as possible be removed to an asylum’.250
Case Studies: Restraint,
Neglect and Cruelty
The 1858 commission’s strong endorsement of asylums as the central element of care for the mentally ill was all the more remarkable in light of the disturbing low standards and gross abuses revealed in their report. This was most evident in relation to the use of restraint, a topic to which the commission devoted particular attention:
We feel it is our duty also to notice the culpable disregard with which the 23rd Rule of the Privy Council has in many instances been treated. This rule requires that ‘The manager is to take charge of the instruments of restraint, and is not, under any pretence, to allow the unauthorized use of them to any person within the establishment; all cases placed under restraint, seclusion, or other deviation from the ordinary treatment, are to be carefully recorded by him in the daily report, with the particular nature of the restraint or deviation resorted to; but in no case shall the shower-bath be used without the authority of the physician’.251 And, by rule 4, he is to enter in the Morning Statement Book ‘the names of those under restraint or seclusion, and the causes thereof’. In some instances, the managers informed us that they were not even aware of the rule, although a printed copy of the Privy