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Hearing Voices. Brendan Kelly
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isbn 9781911024446
Автор произведения Brendan Kelly
Издательство Ingram
The commission was especially disturbed by specific examples of restraint in Armagh Asylum, examples which some readers might find disturbing. One ‘patient, on the female side, was strapped down in bed, with body-straps of hard leather, three inches wide, and twisted under the body, with wrist-locks, strapped and locked, and with wrists frayed from want of lining to straps; this patient was seriously ill. There was no record of her being under restraint in the Morning Statement Book, as required by the order of the Privy Council. Another female was in the day room, without shoes or stockings, with strait waistcoat and wrist-locks; she had been two years in the house, and almost continually kept in that state day and night’.253
The most egregious abuse, however, was seen in the case of a male patient in Armagh, whose situation was outlined in detail by the commission and which, again, some readers might find disturbing:
A male patient, in Ward No. 2, was found at our visit, strapped down in bed; in addition, he was confined in a strait waistcoat, with the sleeves knotted behind him; and as he could only lie on his back, from a contrivance we shall presently describe, his sufferings must have been great; his arms were, moreover, confined with wrist-locks of hard leather, and his legs with leg-locks of similar kind; the strapping was so tight that he could not turn on either side; and any change of position was still more effectually prevented by a cylindrical stuffed bolster of ticken,254 of about ten inches thick, which ran round the sides, and top, and bottom of the bed, leaving a narrow hollow in the centre in which the lunatic was retained, as in a box, without power to turn or move. On liberating the patient, and raising him, he was very feeble, unable to stand, with pulse scarcely perceptible, and feet dark red and cold; the man had been under confinement in this state for four days and nights, being merely raised for purposes of cleanliness.255
The commission was deeply affected by this case and all the more alarmed to discover that ‘the manager stated he was aware of the man being in bed, but not of his having all these instruments of restraint upon him. No record of the case of restraint appeared in the Morning Statement Book’. They concluded that ‘neither the manager nor physician had seen or visited this patient while under confinement, or even been aware of his state’. The manager in Armagh was Thomas Jackson, who, some thirty years earlier, had worked to improve conditions in the old Dublin House of Industry; clearly, decades spent working in institutional conditions had greatly limited the effectiveness of his reformist zeal.256
Unsurprisingly, the commission found similar problems elsewhere:
We may here mention that in Omagh Asylum we found a bed in use for refractory patients, thus described by the resident physician: ‘It is a wooden bed in the sides, and there is an iron cover which goes over both rails; it is sufficiently high to allow a patient to turn and twist, but he cannot get up … the bars are from twelve to fourteen inches above the patient’s head’.257
Faced with these damning examples of the use, overuse, misuse and abuse of restraint, the commission felt it was ‘scarcely necessary to say that we recommend that the most strict observance of the rule should be enforced; that all instruments of restraint should be kept solely in the custody of the manager or resident physician; that their unauthorised use shall never be permitted, and that all cases of restraint should be daily visited and recorded’.258
These violations of standards regarding restraint were especially disappointing given the emergence of a strong ‘non-restraint’ movement in the late 1830s, some twenty years prior to the commission’s report. Progress in certain English asylums had been significant, if incomplete: the use of mechanical restraints was abolished at the Lincoln County Asylum in 1838; Northampton Asylum (now St Andrew’s Hospital) was the first institution to advocate non-restraint as a philosophy from the time it opened, in 1838; and non-restraint was introduced in Hanwell Asylum by Dr John Conolly (1794–1866) in the summer of 1839.259 Interestingly, the position was very different in the US, where asylum managers were explicitly hostile towards the English ‘non-restraint’ movement.260 In Ireland, however, the Report from the Select Committee of the House of Lords Appointed to Consider the State of the Lunatic Poor in Ireland noted, in 1843, that, for the most part, the ‘system of management adopted in the District Asylums’ in Ireland involved ‘a humane and gentle system of treatment’, with ‘cases requiring restraint and coercion not exceeding two per cent on the whole’.261
Given the stark contrast between, on the one hand, the non-restraint movement in England in the 1830s and apparently low rates of seclusion in Ireland in 1843, and, on the other, the commission’s damning report of 1858, it is unsurprising that the commission’s findings regarding restraint were highlighted in the Journal of Mental Science in January 1859, by Dr John Charles Bucknill (1817–1897), founder of the journal (as the Asylum Journal) in 1853 and editor until 1862.262 In an incisive commentary, Bucknill also drew attention to various other aspects of the 1858 report and the publicly expressed view of Dr Nugent, Inspector of Lunatic Asylums, that the commission’s report was excessively negative and one sided.
Overall, however, despite the objections of Nugent and others,263 and despite the apparently caring attitudes of certain asylum managers, doctors and governors, the picture painted by the commission was undeniably horrific. As the asylums had grown, grotesque institutional apathy had commonly replaced the relatively enlightened ideals of moral management. A bill aimed at remedying matters by implementing the commission’s recommendations was introduced by Lord Naas, the Chief Secretary, in 1859 but did not progress owing to the fall of the government. In 1860, Lord Naas’s successor, Edward Cardwell, made some progress on the matter by having an order in council made by the Lord Lieutenant, establishing a new Board of Correspondence and Control, made up of the two inspectors of lunatic asylums, the chairman and a commissioner of the Board of Works. Real, systematic reform of the asylums would, however, take much longer to achieve.
Life and Death in the
Nineteenth-Century Asylum
A significant step forward was taken on 16 January 1862, when new Privy Council rules were issued, designed to improve the running of district asylums in Ireland and to pacify both visiting and resident physicians.264 These General Rules and Regulations for the Management of District Lunatic Asylums in Ireland covered a broad range of areas, including the role of the Board of Governors; procedures for admission, treatment and discharge of patients; the posts of Resident Medical Superintendent (RMS) and ‘consulting and visiting physician’; and the astonishing range of other posts in the asylums, including chaplains, matrons, apothecaries, clerks, storekeepers, servants, attendants, cooks, laundresses, porters, land stewards, gardeners and gatekeepers.
Particular attention was paid to the precise roles of the RMS and visiting physician, the latter of whom had to visit the asylum three days each week, and every day if the number of patients exceeded 200. Either the RMS or visiting physician had to examine the mental state of each patient at least once every fortnight. Discharge, for the most part, required an order from the board on a certificate signed by both medical officers, but discharge of a ‘dangerous lunatic’ required a joint certificate from the medical officers that the patient was no longer dangerous. The 1862 rules, which strongly favoured the RMS (‘he shall superintend and regulate the whole establishment’),265 were warmly welcomed in the Journal of Mental Science, which noted that the previous rules (1843) were contradictory and generally unsatisfactory.266
The rules were revised again in 1874 and admission procedures laid out clearly:
Persons labouring under mental disease, for whom papers of application are filled up in the prescribed forms, to the satisfaction of the Board, and who shall be duly certified as insane by a registered physician or surgeon, who shall state on the grounds on which he forms his opinion, shall be admissible into District Asylums, after having been examined by the Resident Medical Superintendent or, in his absence, by the visiting physician or surgeon.267
[…] No patient, other than a ‘dangerous Lunatic’ shall be admitted without the sanction of the Board, except by order of the Lord Lieutenant, or of the Inspectors of Lunatics or one of them, or in case of urgency, when any three Governors or the Resident