circumstances connected with their origin – to discriminate the relative importance of their various symptoms – to estimate the effect of remedies – and above all, to keep steadily before them in despite of every discouragement and disappointment the recovery of the patient as the one great object to be continually aimed at.143
Duncan was nonetheless concerned about the state of Irish asylum medicine, lamenting ‘that the Irish contingent of this Association [the MPA] has hitherto done so little for the practical advancement of the science’, a deficit he linked with the fact that ‘only four out of our twenty-two district asylums are provided with a second resident medical officer’, which greatly hampered the publication of clinical observations and research,144 as well as attendance at MPA meetings.145
In his 1875 address, Duncan emphasised the importance of education for doctors involved in the committal process146 and devoted considerable attention to the role of prevailing social circumstances (‘an artificial state of living’)147 in causing mental disorder:
A striking feature of the present age is that it is one of incessant mental activity. All is hurry, bustle, and excitement. Men have become restless, and are ever seeking some new stimulus in the way of enjoyment, or some new discovery in the path of science. Formerly they were satisfied to jog on quietly in the easy way their fathers did before them; they lived in the same houses, cultivated the same farms, and followed the same fashions they were accustomed to from childhood. They had no real ambition; none of that feeling of discontent with present things which lies at the basis of all improvements. They did not hatch eggs by steam, or make calculations by a machine. They had implements, but no machines. They disliked new-fangled ways, and when they were told of improvements they were reluctant to adopt them. Now all is reversed. The spirit of innovation is abroad. New inventions are continually chronicled, and everyone is anxious to secure the advantage for himself before his neighbour gets a chance. Is it necessary to prove that the greater the activity of the brain the greater must be its liability to disease, and therefore to insanity?148
Continuing in this vein at quite remarkable length, Duncan vehemently denounced a great many features of nineteenth-century life, ranging from ‘the substitution of machinery for handicraft labour’149 to ‘the employment of children in factories’,150 and the consequent ‘loosening of the family bond’ and ‘perversion of the natural feelings and affections’ which ‘indicates a state of mind very favourable to the development of insanity, when circumstances arise calculated to produce it. It lies at the very root of Socialism’:151
I think I am warranted in concluding that there is an amount of brain work going on in the present age far different in kind from, and far greater in degree than, any that was ever known before, and which must play a very important part in predisposing the subjects of it to attacks of insanity. And when we come to ask ourselves the question, What can we do to counteract the evil? I fear the answer to be given is, that, practically, we can do very little. The whole is the result of forces far beyond our power of alteration or control. We can no more change the mechanical and commercial character of the age than we can arrest the sun in his course, or put back the hands upon the dial plate of time. Nor, even if it were possible for the world to return to the condition it was in a century ago, would any of us be willing to give up the advantages of our present state to secure such a result. It must not be forgotten that the evil complained of arises, not from mechanical contrivances in the abstract, but from the abuses connected with their working and incidental to their introduction.152
Duncan was not, however, a man to be easily defeated, not even by the great, unstoppable forces of history. The solutions he proposed centred on various forms of education: medical education,153 public education,154 and a particular form of moral education of the young which he felt held the greatest hope for preventing mental disorder:
Sickness and disease often come in spite of all the precautions that may be taken against them; so completely are the causes producing them beyond the cognisance and control even of those who suffer from their ravages. And if this is so as regards the ordinary ills that flesh is heir to, it is still more remarkably the case as regards the various forms of insanity. Legislative interference here is altogether powerless in providing any prophylactic. Whatever steps are to be taken with a view of securing this end must be the result of individual effort in the education of the young – by which I do not mean merely the kind and amount of information crammed into the head of the pupil, but the whole system of training required to produce a well-adjusted balance between all the intellectual and moral faculties of which man’s higher nature is composed and that physical development of the entire system which reason and observation have shewn to be the best safeguard against the occurrence of such a calamity in after life.155
Duncan’s presidency of the MPA was a significant achievement: the MPA was an important organisation in the development of the profession of psychiatry in Ireland and elsewhere, introducing the Certificate in Psychological Medicine in 1885 and adding general legitimacy to the doctors’ search for professional recognition and prestige during the latter part of the nineteenth century.156 Duncan was a good example of these developments, as he served not only as president of the MPA, but also as president of the King and Queen’s College of Physicians in Ireland (1873–5), and generally typified a certain model of nineteenth-century asylum doctor: enterprising, powerful, prolific and keen to promote asylum medicine in the eyes of other doctors and the public. Duncan died on 2 April 1895 at the age of 83, many years after retiring from active medical practice. His obituaries in the British Medical Journal and Medical Press noted the professional esteem in which he was held, as well as his devotion to the promotion of religion and reputation as a man of charity.157
Ultimately, Duncan embodied a disquieting paradox that lay at the very heart of Irish asylum medicine throughout the 1800s. While his heartfelt, fluent and humane rhetoric was both scientific and compassionate, it coexisted with the growth of an increasingly large, custodial system of asylums ranged across the country. And while Duncan explicitly promoted efforts to prevent mental disorders (in apparent conflict with the interests of those who ran asylums), he lived during a time when the number of asylum beds – and thus inpatients – rose at a genuinely alarming rate, to a level that was as unjustifiable as it was unsustainable.
This yawning chasm between rhetoric and reality was demonstrated vividly in 1843, when a select committee of the House of Lords provided another chilling report on the ‘state of the lunatic poor in Ireland’. Despite the best intentions of Duncan and colleagues, things just kept on getting worse for the mentally ill.
The State of the Lunatic Poor in Ireland (1843):
‘I Could Not Describe the Horror’
The 1840s were an important and formative decade for the Irish asylum system. In 1843 a select committee of the House of Lords provided yet another incisive, disturbing report on ‘the state of the lunatic poor in Ireland’. The Committee noted the recommendations of its predecessor, the select committee of 1817:
On the 4th March 1817 a Select Committee of the House of Commons was appointed to consider the expediency of making further provision for the lunatic poor of Ireland. It was then stated that, with the Exception of one institution in Dublin, one in Cork, and one in Tipperary, there was not a provision made for more than 100 lunatics throughout all Ireland. This Select Committee reported (25th June 1817), ‘that the only mode of effectual relief would be found in the formation of District Asylums exclusively appropriated for the reception of the insane; that, in addition to the asylums in Dublin and in Cork, there should be built four or five additional asylums, capable of containing each from 120 to 150 lunatics’. It further recommended that powers should be given to the government to divide Ireland into districts, and to select the site for an asylum in each, and that the whole expense of the new establishments should be borne by the counties included within the several districts.158
While the 1843 select committee found that significant action had been taken based on the 1817 report, substantial challenges remained:
