Our shameful asylums

For two centuries, mental healthcare in Ireland was ignorant and cruel. Conditions in hospitals were barbaric, with more admissions meaning more profit. It was big business, says Richard Fitzpatrick

TO be mentally ill in Ireland in the 19th century was tough. According to testimony to a committee in the House of Commons, about the Irish, in 1817: “When a strong man or woman gets the complaint [madness], the only way they have to manage is by making a hole in the floor of the cabin, not high enough for the person to stand up in, with a crib over it to prevent his getting up.

“This hole is about five feet deep, and they give this wretched being his food there, and there he generally dies.”

For people placed in ‘lunatic asylums,’ the conditions were harrowing. Cells had stone floors, with little or no heating or ventilation, and were exposed during winter. Given overcrowding, patients (or ‘inmates’ as they were called) were vulnerable to epidemics, euphemistically described as ‘fevers’.

Corpses lay for days without being removed. Patients were restrained with manacles locked on their ankles by a chain so they could be fastened to a bed, and were subjected to bizarre experiments.

“There was a treatment which appears to be especially popular in Cork, called a circulating chair,” says Dr Brendan Kelly, a psychiatrist at the Mater Hospital, and one of the contributors to the book, Asylums, Mental Health Care and the Irish: Historical Studies, 1800-2010. “It was a technique taken from Scotland. A psychiatrist in Cork, a Dr William Hallaran, used a contraption where the patient was placed in a chair by sitting, or it could be by lying down, and was rotated at high speed, maybe 60 times a minute. According to Hallaran’s textbook, in 1810, “in the obstinate and furious,” the swing “generated a sufficiency of alarm to ensure obedience; in the melancholic” it provoked “a natural interest in the affairs of life.”

A feature of mental health care in Ireland over the last few centuries is the rise and the fall of asylums. Cells erected for pauper lunatics in the Dublin City Workhouse, in 1708, are the first record of public provision. Three years later, 10 cells were siphoned off for insane soldiers at the Royal Hospital, Kilmainham.

Dean Jonathan Swift’s Hospital for the Insane opened its doors to 50 fee-paying patients in 1757. By 1851, there were 3,234 individuals in asylums. This had increased to 16,941 by 1914 and peaked in 1963 at 20,000. The impulse, born of the Enlightenment, to construct asylums, was well-intentioned, but they became overcrowded, with disastrous consequences.

“Why did they become so overcrowded? The law changed in the 1800s,” says Kelly. “It became a lot easier to commit somebody to an asylum as a criminal lunatic, even if they had not committed a crime. That legislation created an admission pathway that was very attractive. It meant that a family member that might be ill or disabled, or causing some kind of difficulty, could relatively easily be admitted to an asylum and it was extremely difficult for them to be discharged.

“The asylums reflected broader society. They were not the creation of doctors or asylum managers. For example, while there might have been 2,500 people in St Bridget’s Hospital, in Ballinasloe, or the Richmond Asylum, St Brendan’s Hospital, in Dublin, at various times, you didn’t find 2,500 families queuing up outside wanting to take their family member home.

“They served a very real social purpose at a time of great change in Ireland. Family structure changed with industrialisation. There were fewer families living off the land, where an individual with a disability, or possibly a mental illness, might find a role, for example spending their life working on a farm.”

Asylums also became big business, as was starkly demonstrated in 1919 when Monaghan Asylum was turned into a soviet.

For 12 days, its nurses and patients barricaded their building. A red flag was hoisted on the roof. Peadar O’Donnell, the trade union leader and revolutionary, coached their strike, helping to achieve better pay and conditions.

“The government has been trying to close hospitals for years,” says Pauline Prior, editor of Asylums, Mental Health Care and the Irish, “but nobody wanted these hospitals to close — they were big contributors to the local economy, supporting a huge organisation of doctors, nurses, social workers and local trade. It’s very little to do with mental illness. Did we have nobody mentally ill in 1800, but 20,000 in the 1950s, and 3,000 now? That’s the problem today — it seems to be harder to move money into community-based services, because there are too many vested interests.”

Ireland has the same proportion of people suffering from mental health problems as other countries, despite misconceptions.

“There was some talk of this in the past, and the idea that we have increased rates of mental illness is virtually impossible to eliminate from people’s minds,” says Kelly. “I get emails and calls about this from all over the world, chiefly from American anthropologists. All of the large-scale studies of mental illness indicate that for core mental illnesses — schizophrenia, manic depression — rates are very steady across many countries. We do not have a higher incidence of mental illness than other populations — and we never had.”

*Asylums, Mental Health Care and the Irish: Historical Studies, 1800-2010 is edited by Pauline Prior and published by Irish Academic Press. For more information, visit: www.iap.ie.

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