Linda S. Slusser
Today, St. Patrick’s Hospital in Dublin, known for the innovative care of its patients provides “Ireland’s largest, independent, not-for-profit mental health services.”1 When founded in 1745 by the bequest of Jonathan Swift, it was the first psychiatric hospital to be built in Ireland mandated for the care of “Idiots and Lunaticks.”2
Madness in the Eighteenth Century
Although new theories of madness and more therapeutic approaches to treatment were being proposed in the late 1700’s, during most of the eighteenth century society viewed the lunatic as one who had literally lost his reason, “the essence of his humanity,” and therefore “his claim to be treated as a human being.”3 Treatments, designed “to weaken the animal spirits that were believed to be producing madness,” still included restraints with chains, bloodletting, emetics, purging, and beating.4
Confinement rather than cure was the focus of the earliest institutions in Great Britain. They resembled prisons with cells and keepers to control the inmates. Bethlem Hospital in London had been the first to include lunatics in 1377.2 By the eighteenth century it had become infamous as “Bedlam” and had a reputation for cruelty, neglect, and poor living conditions, with an inadequate diet, rough clothing, and inactivity. Even worse, the mad in Bedlam were displayed as entertainment—a “freak show,” a “spectacle,” a “menagerie” from which “both provincial bumpkins and urban sophisticates could derive almost endless amusement” for a fee.3
Swift and Madness
The earliest biographers of Jonathan Swift reported that he had chosen to found St. Patrick’s Hospital because he had become insane himself at the end of his life. One writer even claimed that he was the first patient to die there. Neither of these conclusions is accurate.5 It was his philosophical views and personal experiences that influenced Swift’s decision to leave his estate for the establishment of St. Patrick’s.
Throughout the eighteenth century, medicine, politics, and literature all debated the relation between reason and madness, a subject that greatly interested Swift. In his most powerful satires, including Gulliver’s Travels and “A Modest Proposal,” he sometimes explored the Lockean theory that “any person could fall into madness by the erroneous association of ideas.”2
But the stronger motivation for Swift’s legacy grew from his involvement with the day-to-day problems of the Irish people,not only as an individual but also as dean of St. Patrick’s Cathedral (from 1713 until his death). At mid-century there were no provisions specifically for lunatics. If not being cared for by their families or found wandering the countryside, lunatics would sometimes be confined with criminals in prisons, with the poor in a workhouse, or with the sick in a hospital. Swift had firsthand knowledge of these conditions since he served as a governor of the workhouse and as a trustee of several hospitals. In 1710, after a visit to Bedlam, he got himself elected a governor there in 1714. By 1731 Swift had decided on his legacy,intending his hospital to be charitable and more humane than Bedlam.2
Another strong motivation may have been Swift’s ability to empathize with the sufferers of madness. Not mental illness but recurring attacks of Meniere’s disease had afflicted him for over fifty years, beginning at age twenty three. The debilitating bouts of vertigo, nausea, tinnitus, and deafness worsened by the late 1730’s, and he complained of memory loss and difficulty in reading and writing. When Swift finalized his will in 1740, he referred to himself as sound in mind but weak in body. In 1742, following a sudden decline in his health, his friends had him judged incompetent and appointed a guardian. Probable dementia increased his helplessness until his death in 1745.5
St. Patrick’s Beginnings
Jonathan Swift left an estate of about 12,000 pounds.1 In his will he listed details as to where St. Patrick’s should be built and how it should be run by his board of governors. Although they first met in 1746, the asylum would not open until 1757. The governors needed to acquire the site, oversee the plan and construction of the building, and ensure available money for operating expenses. Insufficient funds were the main obstacle, even after adding money from rents, donations, subscriptions and Parliament. Finally, St. Patrick’s had to accept paying patients to offset the costs of its charity cases.2
In Swift’s Hospital Elizabeth Malcolm describes what is known or can be inferred about St. Patrick’s first years:
- Following the layout of the seventeenth-century updated structure of Bethlem Hospital, architect George Semple designed St. Patrick’s with a basement, first floor, and second floor. Each ward was a long corridor with an iron gate and a keeper’s room at the entrance. Eight by twelve-foot cellscould accommodate fifty patients and had sturdy doors and high windows.
- The hospital opened in 1757 with sixteen patients and a staff consisting of a master, male and female keepers, cook, laundry maid, housekeeper, porter, and surgeon. Finances quickly necessitated admitting boarders (paying patients) along with pauper lunatics and pauper idiots. Two expansions by 1793 provided one hundred more rooms and, of course, more staff. Yet, with no special training to deal with the mentally ill and treatments limited to baths, purges, bleedings, drugs or restraints, care was still primarily custodial.
- St. Patrick’s continued to grow and change throughout the nineteenth and twentieth centuries to keep pace with evolving insights about mental illness and how it should be treated. Today the vision of one man—a writer whose scathing satire caused some to label him a misanthrope—has truly been fulfilled by St. Patrick’s Hospital—the legacy of Jonathan Swift.Probable conditions for the comfort of patients in the early decades at St. Patrick’s were “definitely superior” to those at Bethlem.2 Heating came from coal fires in the corridors. Cleanliness of patients and their surroundings was a priority. Paupers were supplied with stools, wooden beds, and bedding (straw being used only for violent, destructive patients). Meals likely offered porridge at breakfast, potatoes plus meat three times a week at dinner, bread and milk at supper, and beer occasionally. Boarders brought their own furnishings and would have had a richer, higher quality diet. Also, other than a patient’s relatives, visitors had to show permission from a governor before entering.
- Measured against the standards of the time, the care of lunatics at St. Patrick’s was far above that of other institutions. In 1767 merchant Henry Moore, whose sister was cured at the hospital, thanked God and Swift for its existence. Writing in 1815, Henry Bennet, an advocate of asylum reform, did criticize St. Patrick’s for not separating patients by classifications and for failing to create recreational or occupational opportunities for them. Yet, with these improvements and because the patients were well taken care of in other respects, Bennet believed that no other institution “could be . . . better.”2
1) St. Patrick’s Mental Health Services. St. Patrick’s History and Archives. https://www.stpatricks.ie/history-archives. Published 2016. Accessed September 8, 2016.
2) Malcolm E. Swift’s Hospital: A History of St. Patrick’s Hospital, Dublin, 1746-1989. Dublin, Ireland: Gill and Macmillan; 1989.
3) Scull A. The Most Solitary of Afflictions: Madness and Society in Britain 1700-1900. New Haven, Connecticut: Yale University Press; 1993.
4) Cook M, Pick D, Ffytche M. Madness: Introduction: Deviance, Disorder, and the Self. http://www.bbk.ac.uk/deviance/madness/intro.htm. Published 2010. Accessed September 8,2016.
5) Bewley TH. The Health of Jonathan Swift. Journal of the Royal Society of Medicine. 1998; 91:602-605. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1296961/pdf/jrsocmed00019-0046. pdf. Accessed September 20, 2016.
LINDA S. SLUSSER, M.A., is a retired high school English teacher with a Master of Arts from Kent State University. Her interest in medical issues and the many ways medicine touches the lives of patients began after being diagnosed with scleroderma (systemic sclerosis) in 2000.