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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
This book supports this view to the extent that the emergence of clinical professionals, both medical and nursing, throughout the 1800s and 1900s was inevitably a factor in shaping psychiatric practice in Ireland, as it did elsewhere.17 There is, however, little evidence that the search for professional prestige was the main driver of increased committal rates in Ireland, or that it was unconnected with broader societal concerns driving up admission rates.
In the first instance, the medical and nursing professions were by no means the only or even the main stakeholders in the Irish asylums. In 1951, the town of Ballinasloe in the west of Ireland had a population of 5,596, of whom no fewer than 2,078 were patients in the mental hospital.18 As a result, virtually everyone in the area was a stakeholder in the hospital in one way or other, and there is growing evidence that communities and families were powerful users and shapers of the system, acting in complex and often subtle ways, according to community and family needs.19 Most committals were instigated by hard pressed families, rather than governmental agencies or doctors,20 and it was not uncommon for families to remove relatives from the asylums to work in the summer months and then return them in the winter (‘wintering in’).21 The situation was similar in England, where families used asylums strategically and often with considerable thought.22
Indeed, for much of the nineteenth century, medical opinion was not even required for committal in Ireland, as many admissions were certified by justices of the peace, clergymen or others, and decided by hospital boards or courts. As a result, doctors were frequently obliged to admit, ‘treat’ and attempt to discharge people whom they did not believe to be mentally ill in the first instance.23 There is also evidence that asylum board members used their privileges to facilitate admissions from their own localities, adding further to non-medical factors shaping admission practices.24
Second, while asylums sometimes declined to discharge patients despite family requests, it is also the case that the archives of many asylums are replete with letters from asylum doctors urging families and governmental authorities to cooperate with the discharge of patients, often to little avail. Some families were simply too poor to receive home someone with enduring mental illness or intellectual disability, and argued that that person was better off in the asylum. And when a family could not be found to accept a patient home, the patient might well die in the asylum, confirming asylum doctors’ views that confinement after recovery was actively harmful.25 Some of the stories in this book are moving in the extreme.
Finnane quotes a letter sent to Omagh asylum by a family member in the 1800s, declining the asylum’s request that they take their relative, a patient in the asylum, home: the family member outside the asylum explicitly requested that their relative be let die in the asylum, and that the asylum should only contact them again when the relative died.26 Similar cases are presented by Cox27 and yet more are outlined in Chapter 2 of the present book, as archival case notes demonstrate medical officers at the Central Criminal Lunatic Asylum pleading with the Inspector of Lunatics to permit the release of three brothers who showed signs of physical rather than mental illness; not only did these brothers not need to be in the asylum, the asylum environment was clearly unhealthy – and possibly fatal – for them.28
This issue was again highlighted in the Irish Times in June 2016, which recounted the history of a young man admitted to the asylum in Portrane in 1901, who wrote to his father in 1912 noting that the doctors were keen he be discharged, but that his father refused to accept him home.29 The young man begged his father to take him home, as the doctors recommended, but his father did not or could not yield, and suggested instead that his son should remain in the mental hospital indefinitely. That is precisely what occurred: this unfortunate patient died in the hospital in 1949 and was buried in a little wooden coffin, with no relatives at his funeral. There are two key issues here: the family declining to accept the patient home, and the mental hospital, after robustly trying to send him home, eventually acquiescing with the family’s decision. The doctors were progressive to the extent that they recommended and pressed for discharge, but this was not yet enough: the asylum framework still (in 1912) facilitated long term institutionalisation and, too often, that became the default position. Once again, psychiatry acquiesced to the roles pressed upon it by others (families, judges, the police, and the state in various forms), despite highly progressive voices within psychiatry who sought and worked for change but did not always achieve enough.
There has always been a strong, historiographically neglected progressive tradition within Irish psychiatry, with doctors such as Dr Conolly Norman (1853–1908) at the Richmond Asylum, Dublin in the late 1800s and early 1900s strongly urging alternatives to inpatient care.30 Later analogous figures include Dr Robert McCarthy,31 Dr Dermot Walsh and Professor Ivor Browne, among others.32 The reasons why Norman, for example, did not succeed in his plans for care outside the asylum walls lay not within the medical profession, but within government, which repeatedly frustrated doctors’ efforts to deinstitutionalise, in response to powerful, non-medical vested interests in the asylums. The stigma of mental illness was also relevant: an apparent link between mental illness and danger was indelibly underlined by the Dangerous Lunatic Act 1838 and as long as the asylum stood behind large, grey walls at the edge of the local town, the public felt secure.
Finally, no matter how many doctors, public representatives and other reformers sought to dismantle Ireland’s asylum system, their task was rendered even more difficult by the fact that the asylums also functioned as a vast, unwieldy social welfare system for patients and possibly some staff. In the absence of more extensive, systematic provision for the destitute or working poor, asylums were always going to be full: in 1907, 30 per cent of admissions to the Richmond Asylum came directly from workhouses.33 Exactly a century later, in 2007, the psychiatric service in the Mater Misericordiae University Hospital, just up the road from Grangegorman, reported that 35 per cent of emergency psychiatry assessments were of homeless persons: plus ça change, plus c’est la même chose.34
As a result of these factors, the Irish asylums appeared, for all intents and purposes, immovable, immutable and apparently inevitable features of Irish life for almost 150 years, from the mid-1850s onwards. The only events that produced slight, temporary declines in admission rates were the two world wars, and, once the wars ended, admission rates resumed their seemingly inexorable upward trajectory.35 Much, although by no means all, of this book is concerned with elucidating why this was so.
The Asylums: Social or
Medical Creations?
The history presented in this book leads to the conclusion that the Irish asylum system was a social creation as much as it was a medical one, if not more so. The psychiatric profession was certainly complicit to the extent that asylum doctors permitted and even facilitated the growth of the asylums through their (reluctant) acquiescence to the questionable roles pressed upon them by broader society, and their recurring therapeutic enthusiasms for the broad range of treatments discussed throughout this book, ranging from the moral management of the 1800s to the pharmaceutical innovations of the late 1900s.
Throughout the 1880s and 1900s, determined efforts at reform and moves away from large asylums were continually frustrated by a society with an apparently insatiable hunger for institutionalisation. From the perspective of the early twenty-first century, it is a matter of regret that even greater objections to this state of affairs were not raised by more asylum doctors, attendants or nurses, as legislation such as the Dangerous Lunatic Act 1838 visibly drove up admission rates and the poor conditions within asylums became ever more indefensible. While doctors commonly did indeed object, both publicly and strongly, this book argues that their objections were insufficiently strong and often to no avail.