Custody, Care and Criminality

Forensic Psychiatry and Law in 19th Century Ireland

Brendan Kelly

• Publisher: THP Ireland
• Year: 2014
• Print ISBN: 9781845888299
• eBook ISBN: 9780750958981
• Topic: History
• Subtopic: Irish History
• Index: History

In this fundamentally important work, Professor Brendan Kelly explores the background to Irish psychiatry in the nineteenth and early twentieth centuries, charting its progress and development. Using detailed case studies from the original records, the author examines some of the more unusual treatments explored and the history behind them. What emerges is a collection of piercing, untold stories of crime and illness, drama and tragedy. They are filled with a sense of the powerlessness of those detained and the dedicated – and sometimes misguided – enthusiasm of those trying to help. This book sheds important light on the foundations for the treatment of mental illness in Ireland.

1

Mental Health Care in Nineteenth-Century Ireland

INTRODUCTION

The nineteenth century was a time of significant change in mental health care in Ireland. At the start of the century, the majority of individuals with mental disorder or intellectual disability were either living with their families, homeless or placed in workhouses or one of the few asylums that existed at that time.¹

While there may have been few asylums, there was already substantial enthusiasm for new treatments for ‘lunacy’ within those asylums. The first part of this chapter explores some of the treatments used in a particular Cork asylum in the early 1800s, including bleeding, purging, ‘moral treatment’, a broad range of medications (e.g. digitalis, opium, camphor and mercury) and the infamous ‘Dr Cox’s Circulating Swing’.²

Asylum care was, however, the exception rather than the rule at the start of the 1800s, and the second part of this chapter examines the fate of the much greater number of individuals with physical or mental disorders who entered the Irish workhouse system during the nineteenth century. This exploration is based on examination of original workhouse records and minutes from the Ballinrobe Poor Law Union, County Mayo, which was located in an area especially badly affected by the Great Famine (1845–1852).³

The therapeutic enthusiasm within the asylums (as demonstrated in the Cork asylum) and the difficult conditions facing the physically and mentally ill outside the asylums (as demonstrated in the Ballinrobe Workhouse) formed the background to the great asylum-building era of the 1800s, which is examined in the next chapter.

DR WILLIAM SAUNDERS HALLARAN AND PSYCHIATRIC PRACTICE IN THE EARLY 1800s

In Ireland, there was scant provision for individuals with mental disorders throughout the seventeenth and eighteenth centuries.⁴ In 1817, the House of Commons (of Great Britain, then including Ireland) established a committee to investigate the plight of the mentally ill in Ireland. The committee reported a disturbing picture:

When a strong man or woman gets the complaint [mental disorder], 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.⁵

The situation in nineteenth-century Ireland was not unique, as the majority of individuals with mental disorder in Ireland, England and many other countries lived lives of vagrancy, destitution, illness and early death.⁶ Toward the end of the 1700s there were, however, signs of reform, most notably in Paris where Dr Phillipe Pinel (1745–1862) pioneered less custodial approaches to asylum care,⁷ and York where William Tuke (1732–1822), an English Quaker businessman, founded the York Retreat in 1796, based on policies of care and gentleness, combined with benevolent medical supervision.⁸

These reforms were accompanied by a clear commitment to the ‘moral management’ paradigm of treatment.⁹ This approach was based on the idea that ‘insanity’ found its roots in disorders of the emotions and thoughts, and that traditional medical treatment and physical restraints might not always be appropriate. The principles of moral management included the idea that the doctor should speak with the patient in a rational fashion, and the patient should have a healthy diet, exercise frequently and, where possible, engage in gainful occupation.

Jean-Étienne Dominique Esquirol (1772–1840), a French psychiatrist, described moral treatment as ‘the application of the faculty of intelligence and of emotions in the treatment of mental alienation’.¹⁰ This approach represented a significant break from the past which had emphasised custodial care rather than engagement with the patient as an individual. Today, such an approach would likely be described as ‘milieu therapy’ involving the establishment of therapeutic communities and a group-based approach to recovery.¹¹

MENTAL HEALTH REFORM IN IRELAND

In Ireland, the leading proponent of these kinds of reforms was Dr William Saunders Hallaran, the most prominent and prolific Irish psychiatrist of the nineteenth century.¹² Born in 1765, Hallaran studied medicine at Edinburgh and spent much of his working life as Senior Physician to the South Infirmary and Physician to the House of Industry and Lunatic Asylum of Cork. Throughout his career, Hallaran was not only an industrious and progressive clinician and teacher, but also a tireless advocate for a more scientific and systematic approach to mental disorder and its treatment.

In 1810, Hallaran published the first Irish textbook of psychiatry, impressively titled An Enquiry into the Causes Producing the Extraordinary Addition to the Number of Insane together with Extended Observations on the Cure of Insanity with Hints as to the Better Management of Public Asylums for Insane Persons.¹³ This book outlined many of the central themes that defined Hallaran’s approach to the treatment of mental disorder, including:

• Recognition of physical or bodily factors (e.g. syphilis) as important causes of mental disorder

• Deep concern about the apparent increase in mental disorder in nineteenth-century Ireland, a concern which Hallaran shared with many others at that time

• Engagement with the causes, courses and outcomes of mental disorder in a more systematic fashion than was customary

• Careful reconsideration of traditional treatments, such as blood-letting, vomiting and purgatives, which were widely used during this period

• Detailed exploration of novel treatment modalities, such as ‘Dr Cox’s Circulating Swing’

• Careful re-evaluation of traditional medicinal remedies, such as digitalis (foxglove), opium, camphor and mercury

• Critical re-consideration of other contemporary, non-medicinal, physical treatments for insanity, such as shower baths, diet and exercise

• The role of physical factors in causing mental disorder

In the opening section of his 1810 textbook, Hallaran clearly outlined the importance of physical or bodily factors (such as infections) in causing mental disorder in many people:

A principal object of this essay is to point out what heretofore seems to have escaped the observation of authors on the subject, namely, the practical distinction between that species of insanity which can evidently be referred to mental causes, and may therefore be denominated mental insanity, and that species of nervous excitement, which, though partaking of like effects, so far as the sensorium may be engaged, still might appear to owe its origin merely to organic [i.e. physical or bodily] injury, either idiopathically [i.e. inexplicably] affecting the brain itself, or arising from a specific action of the liver, lungs or mesentry; inducing an inflammatory disposition in either, and thereby exciting in certain habits those peculiar aberrations, which commonly denote an unsound mind. That this distinction is material in the treatment of insane persons, cannot well be denied, any more than that the due observance of the causes connected with the origin of this malady, is the first step towards establishing a basis upon which a hope of recovery may be founded.¹⁴

This distinction between causes ‘of the mind’ and physical or bodily causes of mental disorder was clearly important when planning treatment:

In the mode of cure, however, I would argue the necessity of the most cautious attention to this important distinction, lest as I have often known to be the case, that the malady of the mind which is for the most part to be treated on moral principles, should be subjected to the operation of agents altogether more foreign to the purpose; and that the other of the body, arising from direct injury to one or more of the vital organs, may escape the advantages of approved remedies … this discrimination has been found to be of the highest importance where a curative indication was to be looked for, nor need there be much difficulty in forming a prognosis, where either from candid report, or from careful examination, the precise nature of the excitement shall be ascertained.

Hallaran paid particular attention to his belief in the role of the liver in causing mental disorder, recommending that ‘the actual state of the liver in almost every case of mental derangement should be a primary consideration; even though the sensorium should be largely engaged’. Hallaran concluded his textbook’s opening discussion by re-emphasising both the distinction and the links between the ‘sensorium’ (or mind) and the body:

Here we have sufficient evidence of the existence of insanity on the principle of mere organic [i.e. physical or bodily] lesion; holding a connection as it would appear, with the entire glandular system. Hence we may be led to suppose than an imperfect or a specific action in certain portions of this important department tends to lay the foundation of that affection, which I would under such circumstances, denominate the ‘mania corporea’ of Cullen; including at the same time within this species, the different varieties of the complaint as described by authors, depending upon the various causes, whether mechanical or otherwise, as affecting the sensorium, and the other important organs of the animal economy.

This opening discussion clearly outlines one of Hallaran’s greatest contributions to psychiatric thinking: a clear recognition of the importance of physical or bodily factors in causing certain cases of mental disorder.¹⁵ As he concluded this discussion, Hallaran made reference to Dr William Cullen (1710–1790), a prominent Edinburgh physician who had a substantial influence on a generation of leading asylum-doctors including Hallaran, John Ferriar, Benjamin Rush and Thomas Trotter, author of A View of the Nervous Temperament.¹⁶ Cullen was the first to use the term ‘neurosis’ to describe various mental disorders that occurred in the absence of any physical or bodily illness. Consistent with this, Hallaran’s distinction between mental factors and physical or bodily factors in causing mental disorder laid the foundation for much subsequent progress in determining the causes of insanity throughout the nineteenth and twentieth centuries.

Syphilis, for example, was a major cause of admission to psychiatric institutions throughout nineteenth-century Europe, with syphilitic ‘general paralysis’ accounting for over 30 per cent of voluntary admissions of men to Sainte Anne asylum in Paris between 1876 and 1914 (Chapter 3).¹⁷ ‘Syphilis-related disorders’ would later be one of the three main focuses of the Würzburger Schlüssel classification of psychological disorders in Germany.¹⁸ Hallaran gathered the first systematic data on the apparent causes of psychiatric admissions in Ireland and also found that a significant proportion of psychiatric disorders in Cork were attributable to venereal disease, including syphilis.¹⁹ Combined with observations from Paris and elsewhere, these findings further supported the emphasis that Hallaran laid on the relevance of physical or bodily factors (such as syphilis) in causing many cases of mental disorder.

‘THE EXTRAORDINARY INCREASE OF INSANITY IN IRELAND’

The next topic to concern Hallaran in his 1810 textbook was the ‘cause of the extraordinary increase of insanity in Ireland’:

It has been for some few years back a subject of deep regret, as well as of speculative research, with several humane and intelligent persons of this vicinity, who have had frequent occasions to remark the progressive increase of insane persons, as returned at each Assizes to the Grand Juries, and claiming support from the public purse. To me it has been at times a source of extreme difficulty to contrive the means of accommodation for this hurried weight of human calamity!

Characteristically, Hallaran believed that the reasons for this apparent increase in insanity related to both ‘corporeal’ (physical or bodily) and ‘mental excitement’ (in the mind):

To account therefore correctly for this unlooked for pressure of a public...

Table of contents

• Cover
• Title Page
• Dedication
• Contents
• Foreword by Professor Harry Kennedy
• Acknowledgements
• Introduction
• 1 Mental Health Care in Nineteenth-Century Ireland
• 2 Creating the Asylums and the Insanity Defence
• 3 Women in the Central Criminal Lunatic Asylum, Dublin, 1868–1948
• 4 Clinical Aspects of Criminal Insanity in Nineteenth- and Twentieth-Century Ireland
• 5 Reformation and Renewal: Into the Twentieth Century
• Notes
• Bibliography
• Copyright