Cheyne suffered from depression and in 1843 wrote a striking book titled Essays on Partial Derangement of the Mind, in Supposed Connexion with Religion.62 Cheyne’s monograph was notable for his detailed engagement with the signs and symptoms of insanity, based largely on his conversations with persons who were mentally ill63 but also drawn from his personal experience of depression, which he attributed to a life of overwork.64
More specifically, Cheyne rooted his reflections in what he had ‘learned from observation; from having long witnessed the passions and affections in unrestrained action; from having long viewed the drama of life from behind the scenes, and attended to the manifestation of character in health and disease; from his having been for some years in superintendence of considerable number of insane persons, nearly one hundred; and, lastly, from introspection, especially while suffering from lowness of spirits, arising from dyspeptic nervousness, aggravated by the wear and tear of a life of continued over-exertion’.65
Based on his affecting phenomenological descriptions of various disturbed states of mind, Cheyne concluded that ‘mental derangement’ could arise:
First - From a disordered condition of the organs of sense.
Secondly - From a disorder of one or more of the intellectual faculties.
Thirdly - From a disorder of one or more of the natural affections and desires.
Fourthly - From a disorder of one or more of the moral affections.
Fifthly - From groups of faculties and affections being disordered, thereby involving derangement of the whole mind.66
Cheyne presented four overall conclusions, based on his clinical work and the observations outlined in his book, generally linking mental illness with physical disorders:
I.That mental derangements are invariably connected with bodily disorder.
II.That such derangements of the understanding, as are attended with insane speculations on the subject of religion, are generally, in the first instance, perversions of only one power of the mind.
III.That clergymen, to whom these essays are particularly addressed, have little to hope for in placing divine truth before a melancholic or hypochondriacal patient, until the bodily disease, with which the mental delusion is connected, is cured or relieved.
IV.That many of the doubts and fears of truly religious persons of sane mind depend either upon ignorance of the constitution and operations of the mind, or upon disease of the body.67
Cheyne’s work is notable for the careful attention he devoted to the signs and symptoms of mental disorder,68 the links he drew between mental symptoms and physical illness, and his identification of the role of alcohol in precipitating mental disturbance, leading him to advocate abstinence for those with alcohol problems.69
Despite the relatively (if selectively) progressive approaches of Cheyne, Lalor, Mollan and various others, however, it remains the case that the number of mentally ill persons in institutions continued to rise alarmingly during the nineteenth century and conditions of detention were very, very poor. In November 1844, the inspector, Dr Francis White, found that conditions in Wexford were filthy and patients half starved.70 By1892, the Richmond’s problems had increased greatly too, owing chiefly to overcrowding. The inspector was beside himself:
During the year no relief has been obtained as regards the overcrowding of this asylum. The number of patients now almost reaches 1,500, whereas the asylum only accommodates about 1,100. It is therefore not to be wondered at that the general health of the institution is far from satisfactory, and that the death-rate, as compared with other Irish asylums, is high, amounting to 12.5%, the average death-rate in a similar institution in this country being 8.3%. Constant outbreaks of zymotic disease [acute infectious diseases] have occurred. Dysentery has for many years past been almost endemic in this institution – 73 cases with 14 deaths occurred last year, and it may be mentioned that in no less than three of these cases secondary abscesses were found in the liver.71
Clearly, further, systemic reform was needed at national level to provide appropriate care to the mentally disturbed and minimise the ill effects of Ireland’s large scale institutions. One of the key mechanisms used to pursue this goal throughout the 1800s was revision of mental health legislation. This constant, restless process of legislative change72 was ultimately carried to a point that managed to be industrious, obsessional and almost certainly counterproductive, and was continually accompanied by a rhetoric of care and compassion that rested uneasily with the gargantuan institutions it created and sustained. These matters are considered next.
Mental Health Legislation in the 1800s:
The ‘Dangerous Lunatic Act’ (1838)
Among all of the many pieces of mental health legislation passed in nineteenth-century Ireland, the best known and most notorious was the Dangerous Lunatic Act of 11 June 1838, formally titled ‘An Act to make more Effectual Provision for the Prevention of Offences by Insane Persons in Ireland’. The 1838 Act, as Parry notes, ‘formed the basis of the judicial committal procedure which became the most important mode of admission to Irish asylums’:
In essence, this Act was to a large degree similar to its English predecessor, being introduced following the murder of a citizen by a man who had been earlier refused entry to the Richmond Lunatic asylum. The Act provided for the detention of persons denoting ‘a Derangement of Mind, and a purpose of committing some Crime’, or indeed the detention of persons who were believed, on the basis of other proof, to be insane and hence dangerous. From the beginning committal was notoriously easy to obtain, and for relatives there were considerable advantages in using the Act for it did not require a commitment to take the lunatic back following treatment.73
The Act, which followed from the murder in July 1833 of Nathaniel Sneyd, bank director with the House of Sneyd, French and Barton, by John Mason, and the subsequent newspaper publicity, was passed without parliamentary debate.74 The primary purpose of the Act was to protect the public from the dangers allegedly posed by the mentally ill; its terms of confinement were extremely broad and vague; and, since it permitted the confinement in district asylums of prisoners who appeared mentally ill, people were initially confined to county prisons or bridewells, and then transferred to asylums (often after long delays, sometimes of several years duration).
During the committal process, medical evidence could be heard (and generally was) but was not mandatory, and certificates were signed by two magistrates. The 1838 Act soon became the admission pathway of choice for families seeking institutional care for relatives and a habit grew of encouraging a mentally ill person to commit a minor offence in order to facilitate committal under the Act.75 Discharge from the asylum was only possible when the patient’s sanity was medically certified to the Lord Lieutenant.
Once the Act was passed, transfers from prisons to asylums commenced at once: in the first fortnight of July 1838, 13 people were referred from jails to the Richmond.76 This caused immediate problems because the Richmond was already full but, in January 1839, the Chief Secretary, Lord Morpeth, stated that such transfers were to be accepted anyway, regardless of the number of patients already in the asylum. The asylums further objected that some of the transfers were not suitable for asylums and that inpatient numbers kept on rising, especially since discharge required the authority of the Lord Lieutenant. These very real problems, robustly highlighted by Mollan and others at the Richmond, were largely ignored by the government. Objections in the House of Commons and an 1843 amendment requiring at least one credible witness in each case made little difference either: the 1838 Act quickly became the main mechanism for asylum admission and a key contributor to the intractable overcrowding that blighted Irish asylums throughout the 1800s.77
As Finnane points out, between
