Huge numbers of people ended up in psychiatric institutions in Ireland, often due to social causes, writes MARY RAFTERY

LINES OF naked people, faeces covering the floors, food served up with pitchforks, people deliberately kept in a state of animal-like existence – not exactly the kind of descriptions one expects to come across in Department of Health files.

Nonetheless, all appear in one of the most damning reports on an Irish institution in this country, revealed this evening in Behind the Walls, RTÉ’s documentary series on the history of psychiatric hospitals in Ireland.

The report concerned the Clonmel District Mental Hospital, as it was then, still open today and known as St Luke’s psychiatric hospital. It was written in 1958 by the assistant inspector of mental hospitals, Dr Ramsey, and delivered to the Department of Health in September of that year.

It was a revealing year in the context of Irish mental institutions. The patient population was close to an all-time high of more than 21,000. For many years, Ireland had led the world in locking up its people in psychiatric hospitals – on a per capita basis, it was even ahead of the old Soviet Union.

While for many years there had been anecdotal references to the enormous numbers in psychiatric hospitals, the definitive research establishing the State as a world leader was carried out recently by Dr Damien Brennan of the School of Nursing and Midwifery in Trinity College Dublin.

In addition to his international comparisons, Dr Brennan looked at figures closer to home, in particular comparing numbers locked up in psychiatric hospitals with those in prisons. This presents a truly remarkable picture of Irish society in the mid-decades of the 20th century, where the number of prisoners rarely exceeded 600. In 1958, the year of Dr Ramsey’s Clonmel report, this number was 369.

Compare this with the 900 psychiatric patients locked up in Clonmel alone. Unlike prisoners, they had had no due process, no trial, no hearing, no appeal, and no end to their sentences. Stripped of their basic human rights, they were consigned, often for decades, to conditions so bad that one official in the Department of Health wrote he “was thoroughly shocked at the abysmally low standards in Clonmel”.

What makes this even more horrific are the very clear statements in Department of Health files that Clonmel was not unique. With a view to finding out just how bad conditions were in other hospitals, the Department of Health decided in 1959 to circulate all the resident medical supervisors (or chief psychiatrists) of the 20 or so institutions around the country to ask what improvements they felt should be undertaken in their particular hospitals.

At an internal meeting in October 1959, it was reported that six did not bother to reply while most of the rest were “defensive in tone”. It should be remembered that these were doctors charged with the treatment and wellbeing of their patients.

It is revealing in this context to read a Department of Health official recording the attitude of one resident supervisor to the mentally ill in his hospital. According to this senior psychiatrist, “mental patients are neither happy nor unhappy, they are withdrawn and oblivious of their surroundings, leading little more than a vegetable existence”.

Even such a layperson as the departmental official knew better than this, appending his own remark that, “this, I understand, is nonsense as far as the vast majority of patients are concerned, or would be nonsense if they had not been reduced to a vegetable existence by the environment in which they are forced to live”.

This attitude to patients might go some way towards explaining the longevity of such risky and dangerous psychiatric treatments as lobotomy and insulin coma therapy.

The latter was where patients were injected with enough insulin to put them into a hypoglycaemic coma. This was thought in some mysterious way to be likely to cure them. Of course it did no such thing – rather, it put them at risk of their lives or at least of severe brain damage. It did, however, continue in use for several decades in the mid-20th century, until it became entirely discredited and was abandoned.

The history of lobotomy is equally if not more tragic. It is difficult to obtain precise statistics here, but it is clear it was carried out on significant numbers of patients, particularly in St Brendan’s psychiatric hospital, Grangegorman. It consisted of severing the frontal lobes from the rest of the brain. Many of those operated on were described as being so damaged that they became incapable of independent living or of even being able to use a toilet.

With such huge numbers in psychiatric hospitals undergoing such treatments, a fundamental question arises: were Irish people simply more insane than anyone else?

It is, after all, an entirely logical reason for the record-breaking numbers. However, a canvass of the growing number of young historians increasingly working and researching in this area shows the reasons people ended up in Irish institutions were far more complex, and were often related more to social rather than medical causes.

A particularly poignant visual reminder of the immense tragedy represented by the extraordinary statistics in this area lies in the treasure trove of patients’ personal possessions rescued last year from the attics of St Brendan’s hospital in Grangegorman.

When patients died (to be buried, unnamed, in mass graves in Glasnevin cemetery), their modest few belongings ended up in the attics of the many buildings that make up the complex of Grangegorman.

These were rescued recently by a group of dedicated retired psychiatric nurses who have begun the process of cataloguing them. It is an immense job, with thousands of personal possessions – holy pictures, packets of cigarettes, lipsticks, letters, shoes, rosary beads, photographs, handbags, spectacles.

The process is being overseen by Brian Donnelly from the National Archives, who tours the country saving psychiatric record books and artefacts from oblivion. He highlights the need for statutory protection for these unique and invaluable records, many of which have ended up stored in damp basements as old hospitals gradually close.

That process begs the question as to whether attitudes have really changed about those suffering from mental illness. We are trying to emerge from a system where the doctor/manager/psychiatrist was all-powerful, and where patients had neither say nor control over their lives or treatment.

Given the forbidding, custodial approach dominated for the best part of two centuries, it is perhaps naive to think we have eradicated it in this supposedly enlightened age.

This key issue of power – who has it and how it is used – underlies the second part of Behind the Walls, where we tell the stories of a number of those caught up within the system, including a group of women who were foully sexually abused by their psychiatrist.

One of the women who so bravely speaks out in the documentary about her experience describes her abuser thus: “He was a sexual predator, he was a psychiatrist, it was quite a cocktail . . . The women were totally vulnerable. He got away with it because he had power and he was dealing with the powerless.”

Behind the Wallsis a two-part documentary series produced and written by Mary Raftery. It will be broadcast on RTÉ 1 at 9.35pm tonight, with the second part on Monday, September 12th