be had to those under such dismal circumstances; and I have heard the primate and others express their concern for them; and no doubt but very sufficient subscriptions may be had to set this needful work on foot. I should think it would be a pleasure to any one, that has any intention this way, to see something done in their lifetime, rather than leave it to the conduct of posterity.41
Thus reformed, Fownes suggested a site for the proposed establishment, behind Aungier Street, later site of Mercer’s Hospital.42 He proposed that the new asylum should be surrounded by a high wall, have appropriate staff quarters and contain space for patients to walk around, as well as dedicated accommodation for the most disturbed and scope for enlargement.43 Fownes recommended that the establishment should be supported by subscriptions and that the College of Physicians should advise on the work.
When Fownes wrote his letter to Swift in 1732, he was pushing at an open door with the great author: both men were trustees of Steevens’ Hospital in Dublin and both were deeply concerned with the plight of the destitute mentally ill.44 On 3 April 1735, however, less than three years after he wrote to Swift, Fownes died and was buried in St Andrew’s in Dublin. By this time, Swift was already engaged in planning his iconic hospital, later known as St Patrick’s.45 Today, over three centuries after Fownes established his cells for the mentally ill at the Dublin workhouse, there is a ward in the psychiatry unit of St James’s Hospital in Dublin named in his honour, commemorating Fownes’s unique contribution to early psychiatric care.
Jonathan Swift: Author,
Churchman, Pioneer
On his death in 1745, Jonathan Swift famously and generously bequeathed his entire estate to establish a hospital for ‘idiots and lunaticks’ in Dublin, consistent with Fownes’s initiative.46 This establishment would duly become St Patrick’s Hospital, the first formal asylum in Ireland. As a result of his benevolent bequest, Swift occupies a unique position in the history of psychiatry in Ireland.
Swift was born in Dublin in 1667 and gained a Doctor of Divinity degree from Trinity College in 1702. He went on to become a celebrated essayist, novelist, poet, satirist and cleric, serving as Dean of St Patrick’s Cathedral in Dublin from 1713 to 1745. Swift’s interest in madness may have stemmed from family experiences: Swift was raised by an uncle who developed mental disorder and died when Swift was 21.47
Professor Anthony Clare, who himself became medical director of St Patrick’s Hospital in 1989, studied Swift’s writing on madness in A Tale of A Tub (1704) and Gulliver’s Travels (1726) and found much to comment upon.48 A Tale of A Tub, for example, was Swift’s first major work and in it Swift divided madness into three types: religious, philosophical and political. In book three of Gulliver’s Travels, Swift portrays people trying to extract sunbeams from cucumbers and an architect who seeks to build houses from the roof downwards. In The Legion Club (1736), Swift treats the Irish Houses of Parliament as an asylum, complete with madhouse keeper. Clearly, madness and its management were key concerns for Swift and emerged as recurring motifs in his literary and satirical work.
In addition to his writings about madness, Swift was acutely aware of the reality of the plight of the mentally ill. On 26 February 1714, he was elected as a governor of Bethlem Hospital (‘Bedlam’) in London.49 There is no record that Swift actually attended any meetings but in 1722 it is recorded that he used his position as governor to nominate a certain Mr Beaumont for admission, as Mr Beaumont was reportedly riding through the streets on a horse, throwing money around.50 Swift himself, in a characteristic burst of satire, asked whether, once incurable wards were established in Bedlam, he might possibly be admitted there, on the grounds that he was an ‘incurable scribbler’?51
Swift’s interest in madness and its causes was by no means unique among writers of the day: John Locke, Thomas Hobbes, Alexander Pope, Laurence Sterne and Samuel Johnson all wrote about the subject, sometimes at great length. But Swift was notable for the extent to which he matched his writings with concrete actions, most obviously by becoming a governor of Bethlem Hospital and bequeathing his estate for the foundation of an asylum in Dublin.
By 1733, Swift had made the momentous decision to devote his estate to public benefaction and by 1735 he had settled his entire fortune on Dublin city in trust for the erection of an asylum. The following year, Swift’s London publisher, Benjamin Motte, praised his benevolent intentions but warned sternly against permitting the kinds of abuses and maltreatment reported in English private asylums of the times.52 This was a real issue: English private asylums of the 1700s were the subject of considerable concern in relation to the balance between custody and care. The conditions in which patients were kept, as well as their treatment, were the subject of repeated scandal and outrage.53 Swift was fully aware of the risks and took considerable care with his bequest, frequently redrafting his will in order to ensure, as best as possible, that the institution would be run to a high standard.54
Swift’s own mental state was the subject of considerable speculation and discussion both during his life and ever since. Malcolm recounts several opinions that Swift developed mental illness, based on the views of Samuel Johnson, William Makepeace Thackeray and Sir Walter Scott, among others.55 The idea that Swift became a lunatic gained considerable currency following his death, along with the belief that Swift had, in later life, become a patient at the very hospital he founded. In 1849, Dr (later Sir) William Wilde (1815–1876), an eye and ear surgeon, and distinguished author on the subjects of medicine, folklore and archaeology, wrote an entire book about Swift’s health and recounted that it was rumoured that Swift was the first patient at St Patrick’s, although this was not true.56
These tales about Swift had their roots not only in contemporary gossip and innuendo, but also in the fact that, in 1742, a writ, de Lunatico Inquirendo, was issued, declaring Swift ‘a person of unsound mind and memory, and not capable of taking care of his person or fortune’.57 This writ was issued following a petition from Swift’s friends and consideration of medical evidence, and the declaration made by a jury.
Notwithstanding this writ, it is clear that Swift was not truly mentally ill: a lunacy enquiry was the only legal means by which a person incapable of conducting their own business affairs or looking after themselves could be effectively protected.58 As a result, the writ did not necessarily mean that Swift had become a ‘lunatic’, but simply that he was no longer in a position to manage his own affairs and required assistance, most likely as a result of age-related decline. In fact, Swift lived just three years after these events, largely in isolation, and did not write during these later years.
With regard to the specifics of Swift’s health and possible diagnoses, there were suggestions that Swift may have been afflicted with a form of syphilis,59 but it now appears clear that Ménière’s Disease was most likely the central diagnosis.60 Ménière’s Disease is a disorder of the inner ear that affects hearing and balance, and symptoms include vertigo, tinnitus and hearing loss. Various medical examinations of Swift’s life have concluded that he experienced giddiness, nausea, dizziness and tinnitus, all of which are consistent with Ménière’s Disease, especially from the 1730s onwards. In 1736, Swift complained explicitly about some of these symptoms to his friend Alexander Pope, noting that he could no longer write, read or think clearly because of them.61
Swift also experienced severe memory loss from 1739 onward and may have suffered from cerebrovascular disease (impaired blood supply to the brain), further reducing his abilities and cognitive function. Sir Russell Brain (1895–1966), a British neurologist, was of the view that this was the root cause of Swift’s symptoms in later life, especially his aphasia (impairment of language).62 Ultimately, a great number of opinions have been expressed about Swift’s health and the emergent consensus appears to be that he suffered from Ménière’s Disease during his life and cerebrovascular disease towards the end, possibly contributing significantly to his death.63
It is beyond doubt, however, that, towards the end of his life, Swift did not recognise people familiar to him and lost the
