LITMIR.BIZ

      EARLY-TWENTIETH-CENTURY PSYCHIATRY

      Good lunacy laws should make it possible to obtain care and treatment in asylums with ease, but they should make unnecessary detention difficult.

      Committee on Lunacy

      Administration (Ireland), Second Report

      of the Committee Appointed by the

      Lord Lieutenant of Ireland on Lunacy

      Administration (Ireland) (1891)1

      The early twentieth century was a time of extraordinary change in Ireland with the advents of the Easter Rising (1916), War of Independence (1919–21) and Civil War (1922–3), and establishment of the Irish Free State (Saorstát Éireann; 1922–37). This was also a time of considerable change in Irish psychiatry, as determined efforts were made to move from the asylum based system of the 1800s to a better, more humane model of service provision for the mentally ill.

      The problems presented by the mentally ill were clearly acute: by 1900, the 11 pre-existing district asylums had increased to 22, housing a total of 16,404 patients.2 There were, in addition, 709 patients in 12 private asylums and 4 charitable hospitals; 162 patients in the Central Criminal Lunatic Asylum; 89 patients looked after as single patients in private residences; and some 3,805 patients in workhouses. That came to a total of 21,169 patients in these locations in 1900; the number outside these settings was unknown.

      Nine years earlier, in 1891, the issue of patient numbers was considered (yet again) by the Committee on Lunacy Administration (Ireland), which comprised Sir Arthur Mitchell (Lunacy Commissioner for Scotland), R.W.A. Holmes (Treasury Remembrancer for Ireland) and Dr F.X.F. MacCabe (medical inspector with the Local Government Board).3 The Committee noted that many factors, other than mental disorder itself, contributed to rates of certification, especially among the poor:

      It has been said that ‘human power cannot multiply the lunatics of a country,’ but this opinion is here treated as entirely erroneous, if by lunatics are meant those persons whom the State registers and treats as such; and it must be erroneous, unless the views here expressed are wrong. In point of fact, the lunacy of a country is far from being a fixed amount, which can neither be increased nor diminished. There is no uniform standard of mental soundness or unsoundness which is accepted by all medical men when considering whether a certificate of insanity shall or shall not be granted, nor indeed by any one medical man in all circumstances. The ease or difficulty of getting certificates of insanity may depend, and does often depend, on the object in view, or the results which will follow certification. Circumstances apart altogether from the mental condition necessarily influence the granting of these certificates – the source, for instance, from which any expenditure consequent on the granting of the certificates is to be obtained, cannot fail to have an influence.

      If all this is true of lunacy generally, it is of necessity still truer of pauper lunacy, because, in addition to the lunacy, there is then the pauperism, about the determination of which it is clear there may be uncertainty. A lunatic, for example, will become a pauper lunatic in one locality who will almost certainly remain a private lunatic in another. A rich parish will admit a lunatic as a pauper, whom a poor parish would refuse to admit, and of course, a poor parish will admit him, if the consequent expenditure by the parish is to be small more readily than it will if the consequent expenditure is to be considerable.4

      One of the key variables in this context was the parlous state of Ireland’s lunacy legislation. By the end of the 1800s mental health law had become impossibly complex, frequently contradictory and ultimately impenetrable. In 1886, a definitive tome on the topic was published, impressively titled The Law and Practice of Lunacy in Ireland as Administered by the Lord Chancellor under the Sign Manual Together with a Compendium of the Law Relating to Establishments for the Care of the Insane.5 Written by George Whitley Abraham, Barrister-at-Law and Registrar in Lunacy, the book ran to a total of 752 densely written, convoluted pages, and the indefatigable author did not even live to see his masterwork published: he died when it was with the printer. Nonetheless, Abraham’s impressive book presented useful, if lengthy, accounts of topics ranging from the ‘general policy of laws concerning the insane’ to ‘management of the lunatic’s estate’, from ‘civil contracts’ to ‘varieties of incapacity attaching upon lunacy’, and included a ‘compendium of the law relating to establishments for the care of the insane’. Ultimately, however, there was no hiding the fact that the legal position of the mentally ill was a desperate mess, albeit an exhaustively documented one.

      The matter was stated even more directly in 1891 by the Committee on Lunacy Administration (Ireland) which concluded, with admirable brevity, that ‘fresh Lunacy legislation for Ireland is beyond question necessary’:

      In regard to many matters it is extremely difficult, if not impossible, to know what is, or is not, statutory. For this reason alone, the codification or consolidation of the Statutes relating to Lunacy appears to us to have become necessary. But, apart from this, the provisions of the Statutes are in many respects of an undesirable character. They do not sufficiently guarantee the proper treatment of the insane, nor do they adequately safeguard the public against unnecessary detention in Asylums.6

      In terms of service provision, the Committee suggested ‘that it be considered whether some of the empty Workhouses could not be acquired and converted into’ provincial asylums:

      If this were done, the buildings would cease altogether to be Workhouses, and would be as unconnected with the Poor Law Authorities as District Asylums. In this way increased Asylum accommodation might be cheaply obtained in those cases in which extensive structural changes would not be necessary for the conversion of the Workhouse accommodation into Asylum accommodation, and in which the acquisition of additional land would not be needed. Sometimes the necessary structural changes are very extensive and costly […]. But there may be other unoccupied Workhouses which could be altered at small cost so as to afford suitable accommodation for incurable and easily-managed Lunatics, and our suggestion is that the possibility of utilising some of the disused Workhouses in this way should be carefully considered.7

      The Committee suggested ‘the creation of a General Board of Lunacy for Ireland’8 and various changes to administration9 and admission procedures.10 It also supported the idea of lunatics ‘boarding out’ of workhouses, in private homes:

      It would not be difficult, in our opinion, by co-operation between the Lunacy Inspectors and the Local Government Board, to make such rules and arrangements as would afford a reasonable security that the money given for the relief of lunatics so boarded out of Workhouses, whether with relatives or with strangers, was spent for their benefit. If this reasonable security were obtained in such a way as to enable the Inspectors of Lunatics to certify that they believed the boarded-out pauper lunatics to be properly cared for, it seems to us only right that there should be participation on their account in the Grant from Imperial Sources towards the maintenance of the insane poor.11

      Sadly, the Committee’s relatively enlightened and compassionate stances on many matters were generally not reflected in policy changes,12 although the early years of the 1900s did see continued discussion about possible reform along these and other lines. Issues

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