INTRODUCTION BY ROSITA BOLAND:

I first heard about this Portrane document by chance while meeting up with an old friend of mine, Declan Jones.

In 1988, Declan, then an architectural student at UCD, was working on his dissertation; the topic was mental-health architecture. Through a tutor’s contact, he was given an introduction to visit the old Portrane asylum in Dublin.

“I was met by a young doctor, who briefly took me around and then left me to my own devices,” he recalls. “Many areas of the hospital were already effectively closed down, and it was at a time when there was a move to house patients in smaller housing units in the community. Thus staff numbers were reducing and some offices seemed to be in pack-up mode with cardboard boxes around.”

The doctor showing Declan around took out a sheaf of papers from a cabinet in one of these offices that were full of half-packed boxes, and gave it to him. “He just said that it might be useful; it was some memoir and anecdotes left behind by a former colleague when he had retired.”

Declan offered to photocopy the papers, which were themselves a copy. “The doctor said, quite casually, ‘No need to do that. They’re just lying around here and I don’t know what to do with them.’ ”

So Declan stored the 6,500-word document in a box in his parents’ garage when he graduated and left Ireland for Germany. It remained there for many years. At one point, Declan wondered if he should retrieve the papers, and send them to a historical society in Portrane, but never did.

By the time we talked about them, the documents were in Sweden, where Declan spends part of the year. He had never thrown them away; he had, in fact, taken the trouble to have them shipped to his house in Sweden.

Declan’s partner in Sweden went hunting for the papers, scanned them, and emailed them to me in Ireland.

There is no name to the piece, but the author, who is almost certainly male, says within it that he first went to work in Portrane asylum, as it was then known, “as a clinical clerk in the mid-1950s.” He wrote this short memoir in 1981, which he titled simply St Ita’s Hospital, Portrane.

ST ITA’S HOSPITAL, PORTRANE:

‘AS A CLINICAL CLERK, YOU WERE TAUGHT TO OBSERVE BUT TO KEEP YOUR MOUTH SHUT’

This piece was written in 1981 by an unknown former member of staff, who had first come to work in Portrane in 1955

A short early background and thumbnail sketch of this hospital through the years since it first opened to receive psychiatric patients in 1901 is hereunder set out. I also include a few anecdotes.

Portrane is a peninsula situated in the northeast aspect of Dublin Bay – looking out on Lambay Island and Howth with Ireland’s Eye, as it were, on the southeast and towards the northeast Rogerstown Quay and its inlet waters, separating Portrane from the renowned horticultural areas of Rush and Lusk, and in the distance Skerries and the Rockabill landmark, further north.

It was on this peninsula a few hundred yards from Tower Bay, at the tip of the peninsula itself, that the government of the day decided to build Portrane Mental Hospital – isolated as far as possible from the mainstream of things, as was the policy throughout the 19th century in the building of mental hospitals in the various towns throughout the country, including England.

Up to 30 years ago, or even 20 years ago, the local “asylum” or “mental home” was seen to be well outside the town or perhaps on the edge of the urban area. But the enormous urbanisation, which began in the late 1950s and reached a high point throughout the 1970s, saw the traditional mental hospital being caught up in a slipstream of housing schemes and supermarkets and all the other social and commercial demands of the present day.

In former years people went out of town to go see the patients at the local asylum. Nowadays they go into town to see the local psychiatric unit; an unavoidable social change or reversal.

Portrane mental hospital was commenced in 1896. Artisans, masons, labourers and carters were employed. The cost was half a million pounds; yes that is what it cost to build this huge extensive “sea” of magnificent brick at the time. The brick came partly from Portmarnock, the then Portmanock brickyard being located near the present railway station of the renowned golfing town; this area is now known as the “clob-lands”. Another supply of brick came from Downshire in Northern Ireland.

As I have said, Portrane cost £½ million to build; wages were a few bob a day, ranging from two pence an hour and overtime for labourers to twice or three times that for masons, carpenters and their helpers, and extra bonuses for overtime. One old-timer a few years ago recalled to me that a load of horse-drawn bricks to the site was rewarded with one shilling and sixpence per horseload from Portmarnock. In short, therefore, the whole complex was planned or programmed in three stages, when laid down in 1896.

The first stage was the acquisition of the Evans estate, which had a big manor house, known as Portrane House, and several hundred acres of land. The manor house was destined to become what I would call the first ever to host the mental health services. For into this edifice was put 28 patients; farm workers mostly, but also some patients with special skills. They came on transfer from Richmond District Lunatic Asylum, and were all well-ordered, trusted types; four attendants were also specially selected to stewart them, as there were kitchen facilities, cooking, washing and also cleaning to be done, and each one of the 28 persons had a job assigned to him: indoor and outdoor, just as in a modern hostel today.

This formed the vanguard of the great movement of patients that was to follow down the years to come.

The next stage was the actual building of the temporary buildings: eight, nine and 11, and excellent structures they were to last for so long and still are. As the tide of patients rose, those temporary buildings were gradually filled by the patients dislodged from Grangegorman, mostly patients of agricultural background and more than likely were from Wicklow and rural Co Dublin and Ardee. The buildings were never demolished for some reason, and those buildings were to become the centre of parochial politics, bureaucratic somersaulting and fiscal blundering in the meantime, and this has lasted even quite close to recent times.

The third stage marked the opening of the main block, which is a huge area and symmetrically formed into a male side and a female side, with a huge administrative block and supplies and catering centre occupying the middle of this hospital building.

When I first saw Portrane as a clinical clerk, in the mid 1950s, there were 1,800 patients in it, male and female of all categories and classifications, ranging from profoundly mentally handicapped children to patients well over 80 years old. As a clinical clerk you were a doctor at the bottom of the ladder (or the pile), taught to observe but to keep your mouth shut. Today that figure is down to 1,000 or a little over, and includes 80 beds for acute psychiatry to serve a catchment area of 200,000 people.

Most of the patient population “chronically” resident in St Ita’s came from Grangegorman – now known as St Brendan’s Hospital, Rathdown Road. Up until 1960 or a little later, there was what I describe as a pernicious practice. Namely, twice yearly a full busload of patients, male and female, arrived to fill vacancies at Portrane from Grangegorman. The reason entered on the patients record was clear and straightforward, but there was no clinical reason, and I quote: “This patient is suitable for Portrane”. I was later to query this in a petulant way. I should never have asked. It was an immature blunder.

At the writing of this meagre historical account of Portrane – St Ita’s – the mental handicap service is almost separate from the psychiatric service. There is a modern, up-to-date psychiatric unit for severe cases backed up by 10 outdoor clinics with indoor and outdoor hostels and day centres; all servicing postal area No 5 of Dublin suburbs and north county. It is a lively team with well-trained consultants, experienced and tried, with a small team of community nurses of excellent material, who are the backbone of our follow-up services, with two experienced social workers on hand to help and advise. The mentally handicapped service is developing firmly and gaining excellent confidence, and when the working party report on the division of services is examined, there will be better days ahead.

In the winter of 1964-65 our present admission unit was set up. It was a flat-roofed building opened in 1950, built with Irish Hospital Trust money.

The catchment areas for the various psychiatric teams in the Dublin Health Authority were “struck” and defined by Prof Ivor Browne shortly after he became the chief psychiatrist to the authority and Dublin postal area 5 with rural area north Co Dublin as the catchement area totally served by St Ita’s psychiatric team.

As we are aware, the Dublin Health Authority became known as the Eastern Health Board shortly afterwards.

A new Nurses’ Home was built and opened in 1971.

Our own catchment area and admission unit was set up in 1964, a separate unit built in 1950 by the hospital’s trust for elderly people. This was converted and made suitable for admission unit purposes. In 1981 it was reorganised into an acute admission unit and treatment unit, and an assessment unit to rehabilitate patients, male and female and prepare them, successfully, for domestic rehabilitation.

This is the final outcome of a huge programme started in 1965 by Dr Allman, Dr Whitty and Dr Conway. Social rehabilitation, secondly, work rehabilitation and finally domestic or “hostel” rehabilitation.

Dr Tom Bergin was the first clinical director of the mentally handicapped services and automatically set up his office in Portrane and was medical superintendent up until his untimely death in August 1974. I worked on his team, and when the clinical director Dr Michael McGuinness arrived as head of community psychiatry to St Ita’s, we all three managed to start a structural programme, the most dramatic being the beautiful 72 bedded unit on the Howth side of the hospital, housing 72 elderly females. Dr McGuinness continued to encourage capital programmes with upgrading of the old 1896 buildings to meet modern needs.

It was with this same object in mind that the present assessment unit was planned. Their assessment unit is a gem, it is well-staffed, it is innovative and one of the real achievements of the first half of 1981, and certainly a contribution to the year of the disabled and disadvantaged.

In 1980 the Local Appointments Commission recommended the appointment of Dr M Conway to fill the vacancy at St Ita’s Hospital.

The hospital after 80 years had remained steadfast with little fatiguing signs of its sea of bricks. However, a full scale onslaught has been made and an architectural survey is being aimed at. With the appropriate cash flow properly applied and priorities observed should make our hospital liveable and comfortable for the residents, who will have to live out the remainder of their lives therein.

The grounds likewise are very well maintained by our garden staff, but the numbers of helpers by way of patients have dwindled to just a few energetic patients led by Joe Brady, principal gardener.

Anecdotal musings

The type of patient and the staff down the years have always given rise to anecdotal musings and situations. You could only expect this.

As I have mentioned, patients came from Grangegorman by the busload twice a year. They were specially picked for their abrasiveness and behavioural propensities. They came from all walks of life, all parts of the county, among them some broken-down and “drop-out” professionals, such as priests, nuns, doctors, medical students, a barrister or two, publicans, layabouts and so on.

Three such patients found themselves here after being transferred who were by background “knight of the road”. They very quickly took themselves off. At that time it was an unforgivable thing to allow anyone to escape. The three lads were missing for several weeks but eventually located in Haulbowline. They had joined the Irish navy.

Another somewhat amusing story, and absolutely true, emanates from a valid source about the male nurse who in the quiet hours of a winter’s night, when all his 100 elderly male patients were tucked away, decided to have a look at his motorbike, which was out in a corridor. He did a superficial dismantlement, reassembled it and decided to rev it up and down the day room in low gear to test it out.

An elderly patient in his 70s emerged from the dormitory heading for the jacks, colliding gingerly with the nurse, now a motorcyclist. There was a stumble and next day a limp was noticed when the doctor was on her rounds.

She inquired, took a cursory look, made a few medical noises, [and] then the patient boldly told her “that he had been run over by a motorbike during the night”. On the front of his chart, dated March 1923, the reason for admission: “Deluded; says he is being run over by cars and bikes night and day.” And the outcome? “Still harbours delusions. Says he is being run over by motorbikes during the night.”

And there was the time when on Sunday afternoons at least one darling old Dubliner would arrive in with a sweetcan with bacon and cabbage for her inmate son to share with him the family dinner; what a lovely thought and an awareness.

And again I remember one old bachelor brother coming in with biscuits, oranges, and wait for it, a fried mackerel for his elderly sister.

And I recall many years ago an escort going out to bring in a gentleman who was giving himself and family a very rough time with drink escapades. The escort was made up of one doctor, who was anxious to see what happened on escort duty, and an experienced nurse. Whatever happened they were gone for over three hours, when finally at 2am the prospective patient arrived in his car, reasonably sober, for the appropriate treatment, with the doctor and the nurse, mouldy, maggoty, twisted drunk, langers in the back seat.

Not least the funniest of all was a simple, middle-aged chap from the heart of the city visiting his brother, got taken away by time, he apparently could not read the clock; he was then taken back to the ward by insinuating himself into the mainstream of patients without being identified and passed the night away as a lodger. He caused a small chaos in the 24 hourly returns to the head male nurse’s office.

A breakthrough in treatment

The arrival of the powerful chemotherapeutic drugs in the early 1950s created a “breakthrough” in the treatment and management of mental health patients. The whole traditional custodial and authoritarian approach left us, and this fact, together with the liberalisation introduced by the 1945 Mental Treatment Act, created an integral platform, which changed doctor-nurse-patient relationships.

Relatives increased their letters of inquiry, visits, etc, the “open doors” method to encourage breakdown of “locked-up” wards and an ever-increasing effort to create a therapeutic atmosphere became common to all institutions.

St Ita’s had a huge population of mixed categories, and every county in Ireland was represented among its inmates – from the Old Richmond Lunatic Asylum, the old Grangegorman and the South Dublin Union etc – the various hostels for layabouts and down-and-outs together with several hundred broken-down unfortunates from all walks of life were accommodated. There was no admission area or catchment area, no autonomy whatever, but a huge cageful of tired, worn-out persons – because Portrane was the only annex to Grangegorman District Mental Hospital and it was obliged to take any overflow.

On its own beautiful grounds – several lawns, forecourts and sports fields with cricket, hockey, soccer and GAA – Portrane became the ideal mental hospital setting, It was self-sufficient; its own farm produce, dairy produce, beef, vegetables, fruit and flowers, the whole year round.

In contrast to the other provincial hospitals, its staff were recruited from all counties. In places such as Ennis, Castlebar or Ballinasloe, the staff were recruited locally; that is, around the rural areas. Young, strong, able-bodied boys and girls made up the staff of those hospitals and to this day to a large extent.

The laundry

The hospital enjoyed other facilities in that we had our own butcher shop, tailor shop, cobbler shop, and supplies area popularly known as “the stores” and an extensive laundry. The laundry had its own sister in charge but the bulk of the workers were made up of female patients. The types of patient attached to this laundry were distinctively of the hypomanic type; whether this was an occupational stress from dealing with other people’s stress and dirt or the innate illness itself, I don’t know. It could be a mixture of both. How and ever that constitutional type made its way towards the laundry.

The garden – run by Mr Wolohan, RIP – was a delight and a gem, and it was to this man and a group of patients affectionately known as the “Candon gang” who were responsible for the lovely grounds in the vicinity of the hospital at the time. People in the 1920s and 1930s who were acquainted with Portrane and who came to play cricket and hockey referred to the place “with the immaculate grounds”. Unfortunately that standard has now almost vanished because of lack of a patient labour force. The vast bulk of patients arriving here show no interest in horticulture: social welfare has them converted and taken-over and supplanted the work idea. In addition, the patients are short-stay. Together with this is the fact that the older, institutionalised people are becoming aged and unable to work and are dying out and not being replaced.

And from the cosmetic point of view, the roadways through the hospital grounds were attractive and a delight to use; were kept well and hedgerows adorned all approaches. The arrival of affluence – cars and vehicles of all makes – have cut up those roads, which were laid down for horse traffic only in the end of the last century.

One memorable feature of the life and times up until the 1960s was the huge Friesian dairy herd, about 300 in all, which roamed the broad acres of Ballymastone farm and Turvey Avenue. It was a picturesque and sylvan sight to travel on the peaceful avenues on a bright summer’s morning and observe the farm activities in these areas.

A road known as Reilly’s Hill was a stunning scene; now part of Dublin County Council property. At Santry Court was situated another component to the farm and produced large amounts of vegetable and other produce for Grangegorman, now St Brendan’s. A Mr James Hayes was the farm stewart responsible for supervising an employ of about 50 labourers and patients, also the Friesian herd and farm buildings, which were magnificent stone buildings and still with us.

A fascist action

By some sort of genius and faceless bureaucracy a few unnamed officials who could be easily identified and with minimum reference to medical or the nursing staff – those large and valuable acres were sold for development of the Dublin County Council. The proceeds of the sale never came home to roost where most of this money should have, namely St Ita’s. But that is another story.

It was the biggest planned deliberate blunder ever perpetrated. It was not just a mistake – it was a fascist action by nature.

A great opportunity to rehabilitate patients was scrapped and pushed out of the way by people who had no insight or sensitivity to the needs of patients, and just at a time when the new powerful drugs were about to become beneficial. Now we have no place to put patients out into the community except by a highly expensive hostelry system where patients are likely to become institutionalised.

If the farm was not disposed of we could have rehabilitated them on those broad acres of which we were robbed. They would have become self-sufficient because the basis was already there and a fulfilment of human relationships would at least have been attempted. It would be productive and gainful and a natural ting to existence. It was one regretful chapter in the hospital’s history, and those fascists responsible for this chapter should be met with scorn.

The cases of the people mentioned below sketch as accurately as possible the scenario to the social aspects and the varying attitudes to the scourge, not of mental illness, but of social sanctions, stigmata and discrimination towards psychiatric hospitals or settings.

It was a cold day in January 1955 – the after-Christmas refractory period, an anticlimax one would say – and in the large day-room of the mental hospital several figures moved in different directions and with varying postures.

One old chap, about 80 years, looked, fixed his gaze and then half trotted with a rubbery gait. He was tall, lanky and fresh-skinned despite his age. He stretched out his hand to the head attendant and requested with muttered tones, “bit a debaccy, Head”. The head always carried tobacco and matches and a cigarette or two for this purpose. “It’s the best drug of all,” remarked he as he cut from a flat, circular slab of old-fashioned tobacco and handed it to the patient. He was gleeful. “God’s man has come with the debaccy,” was his appreciative mutter as he returned to his accustomed corner of the day room. He always referred to the head nurse as “God’s man.”

“I remember well the night he was brought in,” said the head nurse at the time. “I was a young man on night duty.”

Can you help? Please email rboland@irishtimes.com if you think you know the identity of the author of this Portrane memoir

A PSYCHOLOGIST’S VIEW:

‘THIS FORCES US TO CONSIDER WHETHER THINGS HAVE CHANGED THAT MUCH’

Paul Gilligan is a clinical psychologist and the chief executive of St Patrick’s Mental Health Services in Dublin:

This brutally honest account of life in a psychiatric institution not only provides us with a stark reminder of how badly Irish society failed those with mental health difficulties in the past, but also forces us to consider whether things have really changed that much.

The life-sentence nature of psychiatric detention – at the complete discretion of a psychiatrist without any recourse to independent review or appeal – represented abuse of a fundamental right to freedom and choice unseen in any other realm of society. The institutionalisation and emotional subservience of inpatients was a sad and inevitable consequence.

This system was ingrained throughout all aspects of society: government policy, the legislative system, the psychiatric care system, and was reinforced by public beliefs and attitudes.

The nature of inpatient mental-health care has changed fundamentally since then. Involuntary detention of people with mental-health difficulties is now much less likely, and where it occurs is governed by legislative procedures, which guarantee necessity and the right of appeal and review.

Reading this account reminds us of the failures of the past but, more importantly, provides us with a renewed momentum to ensure these mistakes are not repeated. Changes to legislation, policy and service delivery are not enough. A fundamental shift in public attitudes is required.

Mental-health awareness must become a core part of the school curriculum, and ongoing professional training is needed to tackle the negative beliefs among clinicians, policy makers and health managers. Encouraging people to talk about their distress and seek help when they require it is imperative.

Mistakes of the past are easy to acknowledge but harder to rectify. Acknowledging our own experiences and fears about mental health, confronting our biases and educating ourselves on the true nature of mental health and wellbeing is essential.