In the nineteenth century, Ireland was a country of poverty and food insecurity and respite from the daily struggles of life and the burden of caring for someone who was difficult, not contributing, had a mental disability or were plain, insane, was a factor in admitting individuals to the local district asylum. The Dangerous Lunatic Act of 1838 also meant that someone could be committed to an asylum without medical opinion. It was not essential to have a medical certificate in order for magistrates to admit someone to an asylum. Instead, a family member, friend, employer or other member of the public, could cite their opinion that someone was likely to commit an offence. This resulted in families and communities beginning to use asylums to remove mentally ill individuals or others with intellectually disability or generally unwanted people from the family home. According to leading expert in the history of psychiatry, Professor Brendan Kelly, some families would admit a family member into the asylum at the beginning of winter until the summer farming season begun.
In the 1700s and early 1800s, in an era before public asylums, individuals with mental illnesses were usually treated at home. An inquiry into the treatment of the insane in 1817 discovered that generally family members would dig a pit in the ground of their home, sheds or huts and put the mentally ill person in there. They would close the pit with a grid across the top and feed person through the grid.
Sometimes too, the mentally ill person was abandoned by his family and community. Referred to as ‘lunatics wandering at large’, people with mental illness could end up living quite hard and brief lives. They may live a life with frequent shelter, sleeping outdoors and frequently getting locked up in prisons for an assortment of crimes and misdemeanors. In a way, we were locking up people with mental illness long before the asylums. By passing the Lunacy Act of 1838 and 1845, locking up the mentally ill became legal and instead of pits in homes, or prisons, it was large institutions. While there was a humanitarian underlying philosophy and philanthropic mindset in relation to setting up asylums, in practice, there was often cruelty, lack of empathy and unnecessary restraint and prolonged confinement. The unexpected rapidly rise in admissions and prolonged residency soon resulted in overcrowded, large, impersonal and anti-therapeutic institutions. Despite some of the altruistic aims to improve mental health care and patients lives, the asylum system ended up contributing to an unethical form of social control as well as causing damage to some of the most vulnerable of Irish community.
Its important that we have an awareness of how we are treating mentally ill people in today’s world. Mentally ill are one of the highest groups living on the streets, though asylums have gone, we need to think beyond institutional and community care and the biological approach to mental health. Ivor Browne (former chief psychiatrist of the Eastern Health Board and professor emeritus of psychiatry at University College Dublin), states that we need to have a revolution in mental healthcare and attitudes to mental health and move beyond the same ideas to familiar problems generation after generation.
“Those who do not remember the past are condemned to repeat it”
George Santayana, 1905