was especially unimpressed by Kraepelin’s proposed division of ‘functional’ psychosis into manic-depressive illness (bipolar affective disorder) and dementia praecox (schizophrenia);112 Drapes, like a number of significant others,113 preferred the idea of a ‘unitary’ psychosis.114 This stood in contrast to those who supported the German approach,115 including the influential Norman (RMS at the Richmond), who read a paper titled ‘variations in form of mental affections in relation to the classification of insanity’ before the Medical Section of the Academy of Medicine in Ireland on 28 January 1887.116 In his engaging paper, Norman described previous diagnostic systems as metaphysical and fanciful, rather than clinically meaningful, and welcomed the new, emerging systems.
Unafraid of controversy, Drapes published a paper in the Journal of Mental Science addressing the use of ‘punitive measures’ in asylums117 and, while punishment was used in many asylums in order to maintain order during this period, the Inspectors of Lunatics, following their inspection of Enniscorthy on 4 July 1913, reported a notably low rate of restraint there.118 Even in 1916, by which point the Enniscorthy asylum was ‘considerably overcrowded’, the institution was still maintained ‘in very good order’.119
The following year, at the spring 1917 meeting of the Irish Division of the MPA, Drapes, as chairman, heard a detailed account of the Richmond War Hospital (1916–19), and went on to reflect on the folly of ‘psychophysical parallelism’, or the spurious division between mental and physical symptoms in medicine.120 Given Drapes’s prominence in Irish and British medicine at the time, his emphasis on the continuity between physical and mental symptoms was both influential and prescient, and prefigured many of the developments in psychiatry following the end of the First World War.
Indeed, this issue, the spurious division between mental and physical phenomena, was to remain a theme in clinical practice for many decades to follow and was a key element in the false dichotomies in psychiatry identified by Andreasen, editor-in-chief of the American Journal of Psychiatry, almost a century later.121 Drapes’s insight remains highly relevant to clinical practice today.122
Despite his general independence of judgment, Drapes was not immune to passing trends in medical thought. At the 1910 Spring meeting of the Irish Division of the MPA, in response to a paper by Dr H.M. Eustace on the ‘prophylaxis of insanity’, Drapes spoke about measures proposed elsewhere to prevent the occurrence of mental disorder:
Dr Drapes said that [Dr Eustace’s] paper was highly suggestive. The nineteenth century had been eminent in preventive medicine and hygiene, but mental hygiene had been omitted – Hamlet without the Prince. Medical examination before marriage was good in theory, but stopping marriage would not stop procreation. The public must be educated, and the teaching of the structure and function of the body should commence from infancy. Sterilisation would be even more necessary in improvable cases, those which were discharged quasi-recovered, and these should be given the choice of sterilisation or perpetual detention. He also alluded to the necessity for better teaching of medical men in psychology and psychiatry.123
Like many others who proposed measures such as sterilisation of the mentally ill, Drapes was chiefly motivated by the size of the asylum system and the perceived increase in rates of insanity that underpinned it. Similar measures had been proposed and even adopted elsewhere (e.g. certain parts of the US) at this time.124 Even so, Drapes’s endorsement of sterilisation was a rare and regrettable misstep for one of the leading independent thinkers in asylum medicine in Ireland and Great Britain. Despite advocacy from certain asylum doctors in Ireland, such as Dr William Dawson, eugenics did not gain widespread support in Ireland and the movement did not generally progress.125
In his personal life, Drapes was active in the Church of Ireland and sought to combine adherence to scientific medical principles with commitment to the tenets of Christianity.126 He was on the Synod of his diocese, took a keen interest in temperance activities, and was secretary of the local choir union for some 30 years. The emphasis that Drapes placed on religion was duly reflected in the Enniscorthy asylum, as the Inspectors of Lunatics noted following their 1913 inspection:
Religious ministration receives careful attention. One hundred and forty-one men and 127 women [49% of the patient population] were able to be present at Divine Service on last Sunday. A Roman Catholic and a Protestant Chaplain visit the institution at least twice in the week.127
Drapes’s other interests included chess, croquet and golf. Drapes retired from the Enniscorthy Asylum on 15 May 1919, and though he appeared active and in good health, he died of double pneumonia on 5 October 1919. In his obituary in the Journal of Mental Science, Dawson deeply mourned the loss of an outstanding figure in Irish and British asylum medicine.128 Dawson was, himself, a remarkable figure in Irish psychiatric history, appointed by the War Office in 1915 as a specialist in nerve disease for the British army in Ireland, having previously served in many other prominent roles, including Inspector of Lunatic Asylums in Ireland and president of the MPA (1911).129
Overall, Drapes represented a broadly progressive strand within Irish asylum medicine, focused on patient care and recovery, albeit still within the confines of the custodial Irish asylum system and with the caveat that he was not opposed to considering sterilisation as one way of addressing the apparent increase in insanity that troubled him so much.130 Like many leading figures of his day, Drapes’s thought was dominated by the size of the asylum system and the perception that rates of insanity were increasing uncontrollably.131 This perception, and the debates it stimulated, were a defining feature of this phase in the history of psychiatry in Ireland.
‘The Increase of Insanity in Ireland’ (1894)
Even in the early 1700s there was clear recognition that the needs of increasing numbers of mentally ill persons were not being met by existing provisions in workhouses, prisons or hospitals.132 Concern about the apparent increase in insanity in Ireland grew steadily throughout the 1700s and 1800s, despite efforts to increase provision through the opening of St Patrick’s Hospital, Dublin, in the mid-1700s and various developments and initiatives at workhouses, such as that in Cork, at the turn of the nineteenth century.
By 1810, elucidating the ‘cause of the extraordinary increase of insanity in Ireland’ was a key concern for Hallaran in Cork. In his celebrated textbook, An Enquiry into the Causes Producing the Extraordinary Addition to the Number of Insane together with Extended Observations on the Cure of Insanity with Hints as to the Better Management of Public Asylums for Insane Persons, he wrote:
It has been for some few years back a subject of deep regret, as well as of speculative research, with several humane and intelligent persons of this vicinity, who have had frequent occasions to remark the progressive increase of insane persons, as returned at each Assizes to the Grand Juries, and claiming support from the public purse. To me it has been at times a source of extreme difficulty to contrive the means of accommodation for this hurried weight of human calamity!133
Hallaran believed that the reasons for this apparent increase in insanity related to both ‘corporeal’ (physical or bodily) and ‘mental excitement’ (in the mind),134 as well as ‘the unrestrained use and abuse of ardent spirits’ (i.e. alcohol):
So frequently do instances of furious madness present themselves to me, and arising from long continued inebriety, that I seldom have occasion to enquire the cause, from the habit which repeated opportunities have given me at first sight, of detecting its well-known ravages.135
When an individual had developed ‘the habit of daily intoxication’, Hallaran noted that ‘the countenance now bespeaks a dreary waste of mind and body; all is confusion and wild extravagance. The temper which previously partook of the grateful endearments of social intercourse, becomes dark, irritable and suspicious’.136 The challenges of treatment were only too apparent: ‘Perhaps there is not in nature a greater difficulty than that of restoring a professed drunkard to a permanent
