persons with intellectual disability continued steadily to be admitted to workhouses and asylums throughout the rest of Ireland.85 By 1908, the Royal Commission on the Care and Control of the Feeble-Minded estimated that, based on the 1901 census, ‘there were 5,216 idiots in Ireland, of whom 3,272 were at large, 1,181 were in workhouses, and 763 in asylums’:
As regards the existing accommodation in Ireland, we have shown that the accommodation for these cases in workhouses is absolutely unsuitable; that the provision for those in asylums, although more suitable is by no means ideal, and is unnecessarily expensive; while of the cases ‘at large’ although a minority may be suitably provided for at home, there is ample evidence to show that in the majority of cases the unfortunate patient at home is even in a worse plight than the patient in the workhouse.
With the exception of the Stewart Institution for Imbeciles at Palmerstown, which is entirely supported by charitable donations, and only provides for 103 inmates, there is absolutely no special provision in Ireland at the present time for probably 64 per cent of the uncertified idiots, imbeciles and feeble-minded, or for the majority of the 763 certified idiots in asylums as returned in the Census, 1901.86
Overall, it is likely that the institutional experiences of the intellectually disabled in late nineteenth-century Ireland were similar, in at least some respects, to those of individuals without intellectual disability who were similarly institutionalised and who tended to experience lengthy periods of detention in poorly therapeutic facilities, poor mental and physical health, and a high risk of dying in the asylum: once a person had been detained in an Irish asylum for more than five years, it was almost inevitable that he or she would die there.87
The institutional experiences of the intellectually disabled in Ireland were similar to those in other jurisdictions.88 In Great Britain, the late 1800s saw the management of the intellectually disabled move increasingly out of the private, family sphere and into the public sphere, thus becoming a ‘social problem’, presumed to necessitate the development of institutional provisions.89 This period also saw the emergence of the principle of ‘segregation’ of the intellectually disabled from the rest of society, and a particular commitment to permanent ‘segregation’, deemed to be in the best interests of both the individual and society.90
These public and professional attitudes resulted in widespread institutionalisation of the intellectual disabled throughout the 1800s,91 focused, in Ireland, on the workhouses and emerging asylum system. It is worth noting, however, that the precise nature of the psychiatric institutions across Ireland varied considerably, and there were significant pockets of enlightened practice scattered across the country, where staff sought to humanise conditions and improve outcomes for their patients. The asylum in Enniscorthy, under the punctilious superintendence of the prolific Dr Thomas Drapes, is a good example.
Dr Thomas Drapes:
Asylum Doctor Extraordinaire
Dr Thomas Drapes (1847–1919) was RMS of the Enniscorthy District Asylum in County Wexford from 1883 to 1919, and one of the leading figures in Irish asylum medicine for several decades.92 Drapes’s career was as complex as it was noteworthy, and his legacy was to help shape Irish psychiatry for several decades to follow.93
Drapes was born in Lakeview, Cavan on 17 January 1847, the third son of Dr Thomas Drapes who died shortly after Drapes’s birth.94 His mother moved the family to Kingstown (Dún Laoghaire), County Dublin, and Drapes spent time at a preparatory establishment in Derbyshire before completing his early education at Mr Wall’s private school. In 1864, he went to Trinity College Dublin, from which he graduated in Arts in 1867. He then studied medicine at the Trinity College Medical School and the City of Dublin Hospital. Drapes took the first Medical Scholarship at Trinity College Medical School in 1869, as well as the Purser Studentship and Clinical Medal at the City of Dublin Hospital, before attaining the degree of MB (Bachelor of Medicine; Medicinae Baccalaureus) in 1871. In the same year, Drapes took the Licence of the Royal College of Surgeons in Ireland and the Licence in Midwifery of the Rotunda Hospital.
After completing his training, Drapes was appointed as visiting and consulting physician to Enniscorthy District Lunatic Asylum in County Wexford. Enniscorthy Asylum had opened in 1869, one of 21 such institutions built during this wave of asylum building.95 In 1883, following the death of Dr Joseph Edmundson, Drapes became RMS, a position he held until his retirement on 15 May 1919. As with all asylums during this period, admission rates increased at Enniscorthy, from 4 per 100,000 population in 1871, to 6 in 1911.
The positon of RMS was an extraordinary and, in many senses, impossible one. In 1874, revised General Rules and Regulations for the Management of District Lunatic Asylums in Ireland specified that the RMS was to ‘superintend and regulate the whole establishment, and is to be intrusted with the moral and general medical treatment of its inmates, for whose well-being and safe custody he [sic] shall be responsible; and he shall at all times devote his best exertions to the efficient management of the institution’:96
He shall, before one o’clock, P.M., and also occasionally at other times, inspect the whole establishment, daily – dormitories, – dining-rooms, – kitchen, – laundry, – stores, and other places. He shall go through all the divisions, and see that they are orderly, clean, well ventilated, and of a proper temperature. He shall carefully examine each patient who may seem to require his advice, or to whom his attention may be directed. When going round the female division he shall be accompanied by the Matron or Head Nurse of the division, who shall direct his attention to any matter worthy of attention.97
[…] He shall also visit the male divisions after the patients have retired to rest, and satisfy himself that they are safely and comfortably located for the night.98
Other regulations related to communication with the ‘Consulting and Visiting Physician’ in ‘complicated or difficult cases of mental disease, or any case requiring particular treatment’;99 the RMS being absent from the asylum for a night, which required ‘special leave from a Board of Governors or the Inspectors’;100 the keeping of books101 and minutes;102 ‘disbursement of money’;103 and various other matters. The role of RMS was clearly an extensive and responsible one, both in local asylums and in the criminal asylum at Dundrum.104
During his time as RMS in Enniscorthy, Drapes, in addition to his daily duties, introduced improvements to the establishment including the addition of two new wings, a laundry, kitchen, new drainage system, new water supply, a general heating plant and a mill to supply electricity at an economical rate. Drapes remained, however, primarily a physician, noted for his kindness to patients,105 albeit within the context of the times when institutional practices such as withholding patients’ letters were routine elements of asylum life in Enniscorthy as elsewhere.106
Once he became RMS, Drapes joined the MPA and became an exceptionally active member and enthusiastic contributor to the MPA’s Journal of Mental Science.107 Drapes was elected president of the MPA for the term 1911–12 but declined on health grounds. In 1912, he was unanimously elected as co-editor of the Journal of Mental Science, to which he devoted his considerable energies and intellect: in 1917, the Journal published Drapes’s translation of a paper by Yves Delage, titled ‘Psychoanalysis, a new psychosis’ (‘Une psychose nouvelle: la psychoanalyse’).108 Both the breadth of Drapes’s learning and his myriad intellectual gifts were clear in his deft rendering of Delage’s coruscating critique of psychoanalysis.
In addition to his duties with the MPA and Journal of Mental Science, Drapes took a keen interest in many other matters relating to mental disorder and its treatment. These ranged from the ‘alleged increase in insanity in Ireland’109 to the role of trauma in producing ‘hallucinatory insanity’.110 Throughout his contributions to these debates, Drapes was unafraid to challenge theories he believed to be unhelpful or wrong. This was most apparent in his views on emergent classification systems for mental disorder, systems which he felt should not proceed until there was better definition
