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Hearing Voices. Brendan Kelly
Читать онлайн.Название Hearing Voices
Год выпуска 0
isbn 9781911024446
Автор произведения Brendan Kelly
Издательство Ingram
From the outset, medical conflicts were common in the asylums, especially between visiting physicians and resident medical superintendents: in 1862, the latter was accorded superiority305 and in 1892 the post of visiting physician was abolished in new rules drafted by the Inspectors of Lunatics (then including Dr E.M. Courtenay); this was a defining moment in the emergence of the profession of psychiatry in Ireland.306 The new specialists, increasingly trained in the asylums themselves,307 were immediately confronted with complex tangles of psychiatric, medical, social and legal challenges in many individual cases, with no immediate solutions to hand, apart from further institutional care. These challenges are well illustrated by some interesting cases of folie à plusieurs, a rare but fascinating psychiatric syndrome, drawn from the archives of the Central Criminal Lunatic Asylum in the 1890s.
Case Studies: Folie à Plusieurs
Folie à deux is a rare psychiatric syndrome in which two individuals share symptoms of mental disorder, most commonly paranoid delusions. While there were several clinical descriptions of the syndrome throughout the seventeenth and eighteenth centuries,308 the term folie à deux was coined in the 1870s309 and translated as ‘communicated insanity’ by William Wetherspoon Ireland, a Scottish polymath, in the 1880s.310
The term folie à plusieurs refers to cases of ‘communicated insanity’ in which symptoms are shared by three or more individuals. There tends to be one ‘primary’ patient, whose symptoms are ‘transmitted’ to ‘secondary’ patients. The majority of cases of induced psychotic disorder occur within families and involve, most commonly, mother and child, wife and husband, or woman and sibling.311 Treatment involves identifying the primary patient312 and treating their mental illness and physical disorder (if present); the secondary patient may not require specific treatment following separation from the primary patient. The concept of Capgras à plusieurs (a shared delusional belief that a person has been replaced by a double) has been invoked in relation to the celebrated case of Bridget Cleary, burned to death in 1895.313
From the outset, there were reports of forensic or criminal complications of ‘communicated insanity’,314 including theft, violence,315 attempted murder316 and murder.317 One Irish case from the late 1800s involved two brothers admitted to the Central Criminal Lunatic Asylum on the same day in 1896. Both were single farmers who lived on a family farm. They were charged with the murder of another brother and detained in the Central Criminal Lunatic Asylum ‘at the Lord Lieutenant’s pleasure’ (i.e. indefinitely).318 Patrick, the elder, was 36 years of age and admission notes described him as ‘industrious, honest … timid and nervous’. At the time of admission, Patrick had ‘two brothers and a sister in an asylum’ because ‘all the family became insane at the same time’. Patrick himself was ‘timorous and sleepless, watching an insane brother for about 12 days’. He was diagnosed with ‘acute delusional mania, convalescent’. The cause was ‘hereditary’.
While physical examination on admission to the Central Criminal Lunatic Asylum was normal, the Prison Surgeon’s Report from four months earlier (when the brothers were in prison awaiting trial), noted that they were ‘wild and haggard-looking’. Patrick’s temperature was 100º Fahrenheit (38º Celsius) with a pulse rate of 116 beats per minute (i.e. raised). At night time, the brothers’ conditions worsened: Patrick became ‘wildly delirious, believed there were devils in his cell, sprinkling bed and cell with water, praying constantly, pupils dilated, voice hoarse, spitting frequently … hallucinations of sight and hearing, refused food, slept none that night, were placed in muffs …’
Over the following days, Patrick began to recover, although ‘he remained in a state of the most extreme collapse for some weeks, tongue white and furred, complained of headache and giddiness. Prisoner was kept quiet in hospital and given plenty of milk beef tea and two bottles of stout daily’. Apparently, ‘delirium occurred at night in the different police barracks where [the brothers] were confined previous to committal to prison’.
When Patrick was ‘charged with the murder of his brother’ he said that his (now deceased) ‘brother was insane for ten days previous’. At his trial, Patrick was charged with murder and detained indefinitely at the Central Criminal Lunatic Asylum. Clinical notes record that he ‘recovered from the attack of acute mania from which he suffered while in [prison] and for some days previously; he accounts for the insanity in his family (which occurred almost suddenly) being brought on by “something” they all partook of while at meals, but is unable to say what the nature of this “something” was. He recognises perfectly the crime that both he and his brothers committed and is fully aware that he was at the time “out of his mind”. He has a somewhat down-cast appearance, a slow slouching gait and is depressed in manner and appearance’. He ‘never presented any symptoms of insanity’.
Patrick’s younger brother, John, was admitted on the same day in 1896 with a very similar history. John was diagnosed with ‘acute delusional mania, convalescent’ and he, like Patrick, soon ‘recovered from the attack of acute mania from which he suffered at the time of committing the murder of his brother and afterwards while in [prison]. Patient is very quiet and well-conducted, is in fair health, takes his food well and sleeps soundly. Has been sent with his brother [Patrick] to work on the land and they are both satisfied and pleased to do so’.
Later in 1896, a third brother, Brendan, was also charged with the murder of his brother and detained ‘at the Lord Lieutenant’s pleasure’. Admission notes describe Brendan as ‘very quiet, well-spoken and most respectful; both in manner and appearance he much resembles his brothers … He presents no symptoms of insanity. I consider him perfectly sane; but like his brothers he suffered from an attack of acute mania while in [prison] … He is quite unable to in any way account for the insanity which occurred in his family, he feels deeply the great misfortune which has befallen them and is depressed when speaking of his brother … who was the unfortunate victim of their insanity’.
On admission, Brendan had a history of ‘phthisis’ (tuberculosis) which worsened in the hospital. In 1897, the medical officers wrote to the Inspector of Lunatics stating that Brendan was ‘suffering from effects of detention and presents symptoms of incipient phthisis. We strongly recommend his discharge on the grounds that his disease will be aggravated by his detention’. Despite treatment with cod liver oil, medical notes recorded that ‘phthisis makes itself more evident each day’. The medical officers again wrote to the Inspector of Lunatics stating that Brendan’s ‘condition has become critical and that if he is to be discharged, he should be released at once, as in our opinion, he will soon become too ill to be removed. His temperature at night has reached 102 [º Fahrenheit (39º Celsius); i.e. raised] and in our opinion he will not survive this winter’. After two more weeks, Brendan was discharged to the care of his sister, but died three months later, in late 1897.
Neither Patrick nor John showed any convincing signs of mental disorder during their time at the Central Criminal Lunatic Asylum. In 1898, the medical officer sent a report to the Inspector of Lunatics stating that both brothers were ‘suitable for discharge. They both have been industrious and extremely well behaved since admission here. The only distinction I wish to make is that detention is having a bad effect on John’s health and he may become ill in the same manner as his brother Brendan, who died soon after his being released from here’. Four months later, the medical officer sent an additional report stating that John was now ‘in very delicate health and threatened with phthisis and we consider that he will die from this disease if not discharged soon. We also certify that he may be discharged with safety to himself and others’. Later that year, John was ‘discharged in care of sister’ and three years later Patrick, too, was discharged ‘in care of his sister’, after more than five years in the asylum.
Overall, these cases demonstrate clear forensic complications of folie à plusieurs, involving, in this case, the killing of a family member. These cases occurred in the 1890s, just a decade after the clinical syndrome of folie à plusieurs had been described in detail by Ireland in his collection of clinical vignettes illustrating both clinical and forensic aspects of the syndrome.319 Three years after Ireland’s publication, Dr Daniel Hack Tuke,