Mental Illness

The problem of mental illness was well recognised in the eighteenth century although its origins remained mysterious. Abnormal behaviour provoked fear and hostility, and such treatment as was available was more likely to aggravate than cure the suffering of the afflicted. The treatment of George III during his 1788–9 illness was a case in point, while Dr Edward Jenner, of vaccination fame, found that violent patients could be moderated by making them vomit with tartar emetic.

There was slender provision for the care of the insane in eighteenth-century Ireland, and visitors reported that they were left to fend for themselves. Occasionally the problem was recognised, but the resources were always inadequate. For instance, De Latocnaye discovered that in the hospital at Waterford, ‘which is maintained by subscription and, in part, by a small endowment’, there was specific provision for the mentally handicapped; he adds that ‘this is a matter of great importance, for one of the most painful spectacles to be seen in nearly all the principal towns in Ireland is the number of weak-minded people in the streets.’ For example, he considered that the authorities at Galway should ‘prevent lunatics from running round in the streets’.

Nevertheless, the picture that Carr paints of the institutional treatment of the mentally ill suggests that their lot was often infinitely worse. On visiting the House of Industry at Limerick, where some of the insane were confined, he found ‘madmen stark naked girded only by their irons, standing in the rain, in an open court’.

In 1817 the Commissioners on the Select Committee inquiring into the expediency of making further provision for the relief of the lunatic poor in Ireland found that the existing provision was totally inadequate. Reviewing its antecedents, they reported that:

An hospital attached to the House of Industry in Dublin was originally the only receptacle in that city for persons of the lower classes who were afflicted with mental derangement; and the cells attached to the Infirmaries or Poor Houses in some of the counties were by no means calculated for the restoration to sanity or even for the safe custody of persons who were suffering under so dreadful a malady.

Major institutional arrangements for the insane were made only in 1815, with the completion of the Richmond Lunatic Asylum in Dublin. Authorised in 1810, it was built and supported by parliamentary grant. On its completion, 170 patients were moved there from the House of Industry but within two years the Commissioners found that its provision for 200 inmates was totally inadequate and, as the majority of patients were being sent from the remoter parts of the country, the only solution was the establishment of further similar institutions.

The Quakers were pioneers in the compassionate treatment of the mentally deranged and the Richmond Asylum was, in 1817, being operated on the Pinel system that had been used successfully at the Quaker Asylum near York. It was based on kindness and good sense rather than restraint; the Commissioners reported that there was not ‘a chain, fetter or handicuff’ in the asylum and that any deaths were caused by bodily infirmity rather than the violence of mania.

Thomas Rice, the Commissioner assigned to visit asylums in the south of Ireland, also paid tribute to the work of the Society of Friends: ‘in every public establishment in the South of Ireland which I have visited, I have found the prosperity of the establishment best attended to and its funds most increased by the exertions of one class of individuals … I allude to the Quakers of independent fortunes and stations throughout the South of Ireland.’

He considered that with the exception of Cork there was not a single establishment that could continue ‘for half a year without the exertions and sacrifices of time and money given by the individuals I have alluded to’.

Rice found that the Cork Asylum enjoyed considerable public support and that it was well run. The facilities at Waterford were poor but ameliorated by good management. However, at Limerick he found ‘a contrast to all the merits, and an example of all the faults that I have met with in all the other Asylums that I have visited’. His description and condemnation of the condition of the lunatic poor in Limerick is utterly devastating, and Carr’s strictures on it were still valid more than a decade later.

In Mayo the Rt Hon. Denis Browne (0253) reported that there had been no provision for the mentally ill until the grand jury, receiving £5,000 in fines from illicit distillation, had acquired the building of the charter school. This had been refurbished to provide about 20 cells at a cost of £400-500. The incurables were sent to the Dublin Asylum at a cost of £2 2s per person, but Browne reported that ‘they treat them in the carriages very brutally.’ He then pointed out that:

There is nothing so shocking as madness in the cabin of a peasant, where the man is out labouring in the fields for his bread and the care of the woman of the house is scarcely sufficient for the attendance on the children. When a strong young man or woman gets the complaint, the only way they have to manage is by making a hole in the floor of the cabin not high enough for a person to stand up in, with a crib over it to prevent his getting up, the hole is about five feet deep, and they give this wretched being his food there, and there he generally dies. Of all human calamity I know of none equal to this in the country parts of Ireland.

Adequate provision for the poor and the sick depended not only on resources but also on sustained supervision and interest on the part of all involved. Furthermore, it required a high degree of managerial coherence. Apart from the question of political will, the human capital required to implement proposed solutions was plainly unavailable, and individual reformers were no substitute for it.

Bureaucratic excellence, in fact, was at a premium in the age that divined the first outlines of modern organisation and saw in them the solution to social problems. But it was to be a long and difficult period as the skills required for the effective implementation of social services were gradually hammered out.

For instance, a 1788 review of the results of the 1765 County Infirmary Act showed a far from satisfactory situation. There were on average about ten patients in each of the county infirmaries established under the act, and the buildings left much to be desired. John Howard included them in his visitation of prisons and other institutions, and his remarks highlight the enormity of the problem and the lack of knowledge and resources, combined with a general slovenliness but redeemed by the odd oasis of achievement. A typical report from Howard states:

Limerick County Infirmary - thoroughly repaired, whitewashed and furnished with new bedding - a cleanly and notable matron … Cavan County Hospital. All rooms very dirty, an upper room full of fowls, a dunghill in the small front courtyard … Armagh County Hospital. Built by the Lord Primate in 1768. No baths; nor do I recollect any in use in other county hospitals, though very conducive to the health of the patients.