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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
Finally, it is readily apparent that, at the time of the Famine, both starvation and prevailing deprivation acutely increased social need among the mentally ill21 and also likely led to a worsening of psychiatric symptoms among people with pre-existing mental disorder, both of which increased pressure on asylums to admit people with starvation related distress and intensified mental disorder.22
Analogous evidence for the latter is available from studies of the ‘famine’ which occurred in French psychiatric hospitals between 1940 and 1944, when France was under Nazi rule and rations to French asylums were reduced to levels incompatible with life.23 This resulted in increased mortality in French asylums and a sharp intensification of all forms of mental disorder. The philosopher Simone Weil (1909–1943), herself in an English hospital at the time, died of starvation, possibly in solidarity with the conditions endured by her compatriots in France.24
The famine in French asylums was a specific, demarcated phenomenon which only affected individuals already in asylums, at a particular moment in France’s history. Nonetheless, the deterioration in mental health produced by the lack of food in French asylums provides strong evidence that famine conditions have adverse effects on mental health, at least amongst the mentally ill. This was also the case in Ireland, where persons with worsening mental disorder and starvation related distress sought not only to enter the asylums but also the workhouses, which, despite their drawbacks, at least provided a certain level of care for those with nowhere else to go.
Workhouses and the Mentally Ill:
‘Little More Than a Dungeon’
Even prior to the Famine, destitute persons with mental disorder or intellectual disability had commonly been admitted to workhouses and various charitable establishments, especially during times of social or economic difficulty.25 In 1708, the Dublin workhouse built six cells for persons with apparent mental disorder, intellectual disability or epilepsy.26 The number of places increased to approximately 40 by 1729, but conditions were dreadful: the inmates were chained in foul, unglazed, underground cells with little light or freedom.27
In 1787, the Prisons Act empowered Grand Juries (county administrative and judicial bodies) systematically to establish lunatic wards in houses of industry, and dictated that such wards would be subject to inspection by the Inspector General of prisons.28 The wards were to house insane persons or ‘idiots’ who had to be certified by at least two magistrates.29 The initial response to the 1787 legislation was relatively modest, however, and lunatic wards were only established in Dublin, Cork, Waterford and Limerick.30
As a result, Dublin House of Industry became a major centre for admission of ‘lunatics’ from all over Ireland: between 1811 and 1815, some 754 of its 1,179 admissions came from outside Dublin.31 The investigation ordered by Robert Peel in 1816 recommended that more extensive provision be provided in Cork and Belfast.32 Several decades later, the Commission of Inquiry in the State of Lunatic Asylums in Ireland (1858)33 looked into the matter again and found that the ‘wretched inmates’ in the Hardwicke Cells, connected with the Dublin House of Industry, were ‘in a most unsatisfactory state’. In 1857, these inmates were removed from this ‘disgracefully conducted’ establishment to a ‘new establishment at Lucan’ which was ‘commodious, airy, and cheerful, and every care and attention appeared to be paid to the wants of the inmates, of whom there were ninety-eight at the period of our visit’.
As the 1800s progressed, the Poor Law Act (1838) was introduced to relieve the distress of ‘deserving’ poor in Ireland.34 The system initially consisted of 130 Poor Law Unions, aimed at providing accommodation, food and medical care to the poor of the area. Despite the establishment of several new asylums for the mentally ill during this period,35 many persons with mental disorder or intellectual disability still had to enter the workhouses,36 which generated even greater fear than the asylums did.37 The food was reportedly better in the asylums, compared to workhouses.38
By 1844, there were 957 ‘mentally ill’ persons in workhouses or poorhouses on the island of Ireland and by 1851, towards the end of the Famine, this had increased to 2,393.39 The number continued to rise throughout the remainder of the 1800s, reaching a peak in 1892, when there were 4,198 ‘mentally ill’ persons in workhouses. The previous year, there were some 1,170 ‘idiots’ in workhouses.40 Interestingly, while males tended to outnumber females in public asylums throughout the 1800s,41 ‘mentally ill’ females outnumbered ‘mentally ill’ males in workhouses.42
It is difficult to gain a systematic picture of the specific experiences of the mentally ill in workhouses throughout the 1800s, although conditions were generally very poor and designed to repel,43 as was vividly outlined in the 1817 Report from the Select Committee on the Lunatic Poor in Ireland.44 Efforts were, however, made to improve matters in at least some establishments, albeit with limited success. Ballinrobe Poor Law Union in County Mayo, for example, was located in one of the areas worst affected by the Famine and commonly received persons with mental disorder. In August 1846, a man ‘who was confined to the workhouse as a cured patient from the Castlebar Lunatic Asylum took his discharge and went to his home’; there is no record of his mental state on departure or any attempt at follow up.45 In October 1896, the Ballinrobe workhouse employed ‘a woman at a shilling a day to mind … a woman who is insane’.
Conditions in workhouses were very difficult, not least owing to illnesses such as cholera, typhus and dysentery.46 As a result, there was significant public and official concern about the plight of the mentally ill in the workhouses,47 and it is notable that, unlike the English commissioners in lunacy, Irish inspectors did not approve particular workhouses as suitable for the mentally ill.48 Nonetheless, workhouses rapidly became de facto elements of the system of ‘care’ for the mentally ill during the 1800s,49 as patients were routinely admitted from workhouses to asylums50 and discharged from asylums back to workhouses.51 Relations between the institutions were commonly strained: in 1881, there were 148 persons with intellectual disability or mental illness huddled together in grossly unhealthy conditions in Cork workhouse, and they suffered further during a bitter dispute between the workhouse and the asylum over who was responsible for them.52
Against the background of this close, conflicted relationship between asylums and workhouses, the problem of the mentally ill in workhouses persisted well after the Famine had eased. In 1895, at a meeting of the Irish Division of the MPA in the Royal College of Physicians, Kildare Street, Dr Oscar Woods (secretary of the division) ‘introduced the question of dealing with lunatics in workhouses, and after some discussion, in which the following – Drs Drapes, Finegan, Lawless, John Eustace and the president – joined, the following resolution was unanimously adopted: “That the time has arrived when provision should be made for the large number of lunatics in the workhouses of the country at present uncertified for, not properly cared for, and treated not as lunatics, but merely as paupers, and that a copy of this resolution be sent to the Inspectors of Lunatics”.’53
The concerns of the MPA were strongly supported by admission statistics: Walsh, in an especially valuable study of the Ennis District Lunatic Asylum, County Clare, and the Clare Workhouse Lunatic Asylums in 1901, notes that there were eight workhouse asylums in Clare, housing a total of 263 residents.54 From a diagnostic perspective, 41 per cent had ‘dementia’; 30 per cent were ‘idiots’ or ‘imbeciles’; 20 per cent had ‘mania’; 6 per cent had ‘melancholia’; and 2 per cent suffered from epilepsy. There is also evidence that persons with other conditions, such as delirium tremens (from alcohol withdrawal), were admitted during the 1890s.55
In 1907, at a meeting of the Richmond District Asylum Joint Committee (in Grangegorman, Dublin), the chairman highlighted the magnitude of the issue at the Richmond:
A large number of our admissions come here direct from workhouses. I have looked up the exact numbers and find they