For several women in lower paid professions, poverty, particularly following the onset of mental illness, was more likely. As Melling has found in his study of governesses and female schoolteachers admitted to three Devon asylums, while their domestic means could be modest, it was vital for this social cohort to avoid the publicity of their committal. Melling demonstrates that 'many private teachers relied on connections with the "best circles"' and 'were understandably anxious to maintain some proximity to the privileged world of their employers'.78 Melling also argues that relatives and friends often strove to avoid committing governesses to pauper institutions and struggled to fnance their accommodation at private asylums such as Wonford House.79 These fndings might account for the presence of governesses, schoolteachers and even domestic servants in the voluntary asylums in this study. However, this study suggests that employers, rather than relatives, paid for their maintenance, a privilege they also extended to domestic servants. In Bloomfeld, an unidentifed source contributed £150 per annum for a 'housekeeper and ladies' maid'. Several other unnamed individuals paid between £50 and £150 per annum to accommodate governesses there. Non-relatives paid for the maintenance of several women committed to Stewarts. These included three servants, a governess, a laundress, a stitcher and a teacher, though these were at lower rates (approx. £50 per annum). For example, a Mrs. Jameson, Mrs. Moore and Dr. Leet paid £50, £40 and £30 respectively for the maintenance of a laundress, a servant and a governess. These individuals are among the few in the fnancial accounts whose relationship to the patient was not specifed, implying these individuals were, in fact, employers, rather than relatives or friends. This highlights the high value placed on servants and employees in Irish households and suggests that even outside traditional family settings, friends or employers were willing to invest in voluntary asylum care for women.

While designated occupations were relatively less common amongst female paying patients from rural areas, farming was more common. The percentage connected to farming either directly, through marriage or by birth is shown in Table 4.12. Notably, none of the women admitted to Bloomfeld or Highfeld was in this category, while more than half of female admissions to Ennis (57.9%) and Enniscorthy (63%) were linked to farming. One major difference arises between the two rural samples. At Ennis, a large proportion of farming women were listed as relatives of farmers but at Enniscorthy over one-third were identifed simply as 'farmer'. This mirrors national trends. In Leinster, middle-aged or elderly widows were often reluctant to pass their family farm to a son. In the West of Ireland, 'the transmission of farms between the generations appears to have been accomplished more smoothly' and women farmers were less common.80 Despite their engagement in most kinds of agricultural work, women were not described as farmers either in the census or by themselves unless they were the heads of households.81 This would appear to hold true for paying patients admitted to Enniscorthy. For example, Ellen McC, who was admitted in 1898, aged ffty-three and single, lived with her 'married nephew, but house and place are hers. Has a big farm, over 100 acres.'82 Maria C., a forty-year-old widow admitted in 1897, had overseen her twenty acres and her brother described her as a 'good business woman on farm'.

### Conclusions

Elizabeth Malcolm has provided what she terms a 'superfcial' profle of patients in Armagh, Belfast, Omagh and Sligo district asylums at the turn of the twentieth century. Her fndings suggest that the typical Irish asylum patient was a male labourer, from a labouring or small farming family, Catholic and single.83 Adopting this methodology, between 1868 and 1900, the 'typical' paying patient committed to the district asylums was also a male farmer. He too was Catholic, unless he was committed to Belfast, and single. This remarkably similar profle reveals that paying patients admitted to district asylums differed little from the total populations of these asylums. In contrast, the 'typical' voluntary asylum patient was a Church of Ireland (or Quaker in Bloomfeld) single woman with no former occupation. Given wide variations between the types of patient committed to the private asylums, it is necessary to provide separate 'superfcial profles' for each. The 'typical' admission to St John of God's was a single Catholic man in trade, that to Hampstead was a single Church of Ireland man with an 'other occupation', usually a white-collar profession, and that to Highfeld a married Church of Ireland woman with no occupation.

These profles reveal a great deal about the socio-economic background of the individuals and families who used these asylums. Unlike district asylums, Bloomfeld and Stewarts admitted more women than men. Other asylums such as St Vincent's voluntary asylum (see Chap. 2) and Highfeld private asylum had a policy of admitting only women. This complicates Oonagh Walsh's assumption that non-pauper women in Ireland were more often accommodated in the home.84 Although both MacKenzie and Walsh have argued that families were more willing to pay for male patients' asylum care because of their 'greater economic importance', 85 this study has revealed that in the Irish context, relatives and friends were willing to invest large sums of money in women's care and treatment. While this might suggest a greater determination to 'dump' unwanted female relatives, there is no concrete evidence to support this.

The occupational profle of patients in this study provides some clues as to the sort of people confned in different kinds of institutions. The underrepresentation of those in the most prominent trades of the period suggests that their families could not afford to pay for their care. Whitecollar professionals such as lawyers, doctors and accountants were most often found in voluntary and particularly private asylums. Men and women described as farmers were from a variety of social backgrounds, with signifcant inter- and intra-regional variation and could be anything from a smallholder to a relatively wealthy landowner. The religious profle of their cohort also points towards the Catholic middle classes emerging steadily in rural Ireland. However, members of the Church of Ireland were over-represented in voluntary asylums and in Hampstead and Highfeld, demonstrating that the Catholic middle classes were seeking accommodation elsewhere. Voluntary and private patients' occupational profle corroborates this statement; the occupations listed tended to be dominated by Protestants in this era. While a large proportion of women in this study were described as having had no previous occupation, admissions register entries were concerned with demarcating the economic profle of these individuals and thus demonstrate a wide range of female occupations. A relatively small proportion of women in this study were assigned designated occupations. While work outside the home for women has tended to be aligned with fnancial necessity or even desperation, those engaged in non-domestic work in this study were usually connected to more 'respectable' forms of employment: shop girls, drapers, nurses and nuns. Sources such as these may thus add to our understanding of women and work in nineteenth-century Ireland.

### Notes

### References

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# 'The Evil Effects of Mental Strain and Overwork': Employment, Gender and Insanity

In 1875, an article penned by eminent Irish asylum doctor, Dr. Frederick MacCabe, appeared in the *Journal of Mental Science*. 1 In this piece, MacCabe considered the rising levels of mental strain young men were suffering due to overwork. He claimed that in this period, more than any other, young men were compelled to study more rigorously for examinations, following which they met with greater competition and pressures in their chosen professions. Among those most at risk he counted the commercial, offcial, professional and literary classes. MacCabe was writing in a period of relative prosperity in Ireland. Had he conceived of his article just a few years later, he might have emphasised the mental strain produced by an economic depression that began in 1879 and endured until the mid-1890s. By then, esteemed medical commentators including Daniel Hack Tuke and Thomas Drapes both linked the extreme poverty of the Irish population to high levels of mental illness.2 As this chapter argues, while fear of poverty afficted the rural poor during this era, anxieties about employment and the state of the economy were seen to affect other social groups.

Drapes and Tuke were not alone in relating economic factors to insanity. Labouring men committed to the Hanwell asylum in Middlesex between 1845 and 1850 were considered anxious about their economic future, suffering intense fears of poverty.3 These patients' fears were not emphasised in social commentary or psychiatric literature but rather by their families who named them as major causes for their insanity.4 Following the Great Famine, Irish psychiatric thought had clearly begun to embrace these lay associations. In the south-east of Ireland, certifying medical offcers for district asylum patients often cited fear of poverty, anxiety caused by unemployment and changed circumstances as causes of mental illness, based on evidence that family members had supplied to them. Fears such as these were thought to have a detrimental impact on patients' minds.5

Yet, historians of psychiatry have been curiously reluctant to emphasise medically recognised links between employment and illness in feepaying asylum patients. In her comparison of the causes doctors assigned to York Retreat patients between 1796 and 1823 and 1874 and 1892, Digby found a tenfold rise in 'overwork' or 'over study' and a concurrent rise in 'business and money anxiety'. Despite these stark indicators of a growing reliance on work-related aetiologies, Digby has cautioned against the temptation to interpret this rise as refecting the shift from the romantic age to the 'competitive problems associated with living in a mature capitalist economy afficted with economic depression'. Instead, she infers that her 'fragile data' indicate 'a greater readiness to specify immediately observable features' in everyday life.6 In contrast, this chapter argues that asylum doctors' recognition of certain life events and circumstances as causal factors of mental illness reveals much about contemporary psychiatric associations between employment, economic shifts and mental illness. Digby's fndings might therefore be reinterpreted to refect an increasing movement towards more 'psychological' understandings of mental illness.

In a similar vein, MacKenzie, in her study of Ticehurst private asylum, has argued that, between 1845 and 1915, asylum doctors assigned the causes of anxiety and overwork as 'sympathetic alternatives' to alcohol, based on her observation that some patients attributed these causes were heavy drinkers. According to MacKenzie, the reasoning behind this rested in the Ticehurst proprietors' sensitivity to families' perceptions of what had caused the mental disorder, which they largely echoed.7 The frequent identifcation of alcohol as a cause of mental illness in Ireland reveals that asylum doctors there did not mirror this approach. Moreover, neither Digby nor MacKenzie have apparently made room for the possibility that families, and even patients, cited work-related or fnancial anxieties because they believed they had directly precipitated illness. In fact, patients and their families often reported that the pressures of employment and other economic factors were to blame. Professional opinion could outweigh these lay considerations, however, and this study has yielded no evidence that relatives dictated to the doctors who assigned causes and diagnoses.

Importantly, both medical and lay commentators tended to link employment and mental illness primarily for male patients, with medical offcers characterising male anxieties as a failure to fulfl gendered economic roles.8 However, working-class women were not immune to being assigned fnancial or work-related strain. In early Victorian England, employment was central to the identities of poor women and lack of work was sometimes attributed to their mental illness, by medical practitioners and patients alike.9 In Ireland, women's anxieties about poverty were also aligned with 'maintaining appropriate standards of female respectability'.10 As Chap. 4 discussed, a high proportion of the women in this study did not work outside the home—a trend which increased in proportion to social status or wealth. Yet, women who remained at home played an important role in contributing to the family economy.11 Moreover, a smaller section of women in this study did engage in paid work, while others were property owners. In spite of this, medical aetiologies of wealthier women's illnesses did not tend to hinge on their economic functions in any obvious way. Instead, they focused on domestic circumstances. While the illness of wealthier women in British asylums was also unlikely to be attributed to work-related or fnancial concerns, several scholars have emphasised the links drawn between women's reproductive functions and mental breakdown in contemporary psychiatric literature.12 As Suzuki has argued, 'Victorian middle-class women had hysteria as the disease that symbolised their place in the separate spheres'.13 As will be shown, in Ireland, female non-pauper insanity was attributed to a myriad of factors, the majority of which did not hinge on their biological functions.

This chapter explores the causes assigned to paying patients in the selected asylums. 'Cause of insanity' was recorded in the admissions registers for all the asylums studied except Hampstead and Highfeld. Analysis of these returns is supplemented by a survey of asylum doctors' casebooks, which cast further light on psychiatric defnitions. Lay interpretations are also present in the case notes, where medical personnel recorded information supplied by families, friends and patients.14 In addition, letters written by patients' friends and relatives provide indications of lay understandings.

### Medical Aetiologies

It is often challenging to separate lay and medical defnitions of mental illness. As we have seen, paying patients committed to asylums required two medical certifcates. These forms allowed certifying doctors to record causes of illness and were later transcribed into admissions registers and casebooks, where asylum doctors could choose to confrm or alter the causes assigned.15 Medical rather than lay authorities therefore usually had the fnal say over what was recorded.

Late nineteenth-century asylum doctors distinguished between moral and physical causes of insanity. Moral causes encompassed a range of 'psychological' factors such as grief, bereavement, business or money anxieties, religion and 'domestic trouble', and reveal much about perceptions of the life events or circumstances leading to mental illness. Physical causes, including accidents and injuries, physical illnesses, 'hereditary' and 'alcohol' are less instructive. Physical causes were accorded a pivotal space in the psychiatric discourse of this era, emulating widely held medical theories about the physical nature of mental illness. Asylum doctors in Ireland frequently cited alcohol and 'hereditary' as pathologies closely associated with theories of degeneration.16 This bias towards commonly accepted causes obscures, to some extent, psychiatry's recognition of the 'psychological' causes of mental illness. It is therefore important to explore both explanations to gain a full understanding of the various frameworks embraced.17

As shown in Table 5.1, physical causes were more frequently reported for patients in this study. Among them 'hereditary' and 'alcohol' were

**Table 5.1** Supposed cause of illness of f irst admissions to the case studies, 1868–1900

Compiled from Belfast, Ennis, Enniscorthy, Richmond, Stewarts, Bloomfeld and St John of God's admissions registers

the most often named (Table 5.2). For those assigned physical causes, 'alcohol' accounted for 43% of men and 11.2% of women admitted. This high rate of alcohol-related admissions differs from Britain. While alcohol was recognised as a factor in the admission of private patients to Dundee Royal Hospital in Scotland, it was usually associated with the working classes.18 Alcohol abuse was also less often identifed as a symptom in English private asylum patients.19 In contrast, of the paying patients assigned physical causes in this study, those committed to private asylums were actually more likely (54.8%) than those sent to voluntary (17.7%) or district (19%) asylums to be assigned alcohol. This suggests that alcohol had especially 'Irish' associations. Certainly, during the nineteenth century, the Irish reputation for drunkenness was publicised by English caricaturists to the extent that, according to Malcolm, 'in the English eyes, the Irish became violent, cruel and drunken'.20 While Irish spirit consumption rose in the late 1860s and early 1870s, from 1850 temperance activities resulted in more censorious attitudes towards drunkenness, restricted opportunities for heavy drinking, and more facilities for sober recreation and entertainment.21

The infux of alcohol-related admissions to Irish asylums provoked comment from medical superintendents who observed and contemplated the nature of their patients' inebriety. In England, the decline in alcohol consumption between the 1820s and 1870s has been attributed to several factors including the medical community's increased hostility towards drink and their reluctance to prescribe it as a medicine.22 It is

**Table 5.2** Physical and moral causes by gender most commonly assigned to f irst admissions to the case studies, 1868–1900a

Compiled from Belfast, Ennis, Enniscorthy, Richmond, Stewarts, Bloomfeld and St John of God's admissions registers (a In cases where patients were assigned multiple causes, both are included in this analysis in order to illustrate their statistical signifcance)

plausible that the Irish psychiatric profession shared their English colleagues' hostility.23 Certainly, in 1904 Drapes expressed his frustration at the repeated readmission of habitual drunkards to Enniscorthy district asylum, going so far as to blame excessive drunkenness in Wexford for an increase in insanity there.24 While Drapes was probably commenting on his pauper patients, he evidently did not regard paying patients as being above reproach. This is seen in the case studies. Contrary to Drapes' statement concerning repeat admissions, only thirty-eight patients readmitted to the asylums studied were assigned the cause of alcohol. As Finnane has contended, 'since the insanity of a drunkard was questionable, his or her state when not drunk rarely justifed long detention'.25 For those assigned 'alcohol' whose length of stay is known, almost threequarters remained in the asylum for less than one year. Notably, among those assigned physical causes, alcohol was most commonly attributed to Enniscorthy paying patients (24.5%) compared with those in Ennis (12.1%) and Belfast (6.8%). This implies that Drapes was particularly inclined towards this framework, which is unsurprising given his keen interest in temperance activities.26 Nevertheless, there is little doubt that accommodating the 'drunken' was very much a role for all types of Irish asylums by the late nineteenth century.

Cox and Finnane have identifed alcohol's prominence in the aetiologies of district asylum patients in Ireland. For example, between 1832 and 1922 drink accounted for the illness of 12.7% of patients admitted to the Carlow asylum.27 Both historians have highlighted the absence of inebriate reformatories or retreats in the nineteenth century, suggesting that, in their stead, district asylums became the principal receptacle for this group.28 This argument would go some way towards explaining the high proportion of drink-related admissions among paying patients in district asylums. It does not, however, account for the even greater percentage admitted to voluntary and private asylums. One explanation lies in class-specifc, medical conceptions of 'drunkenness'. In 1875, the lunacy inspectors, discussing the feasibility of establishing 'receptacles for dipsomaniacs', argued that drunkenness among the 'lower orders without social position or means' was treated as an offence or misdemeanour, while among the 'better and richer classes' it tended to be perceived as an 'incipient malady'.29 For the rich, then, a tendency to overindulge in drink may have been treated more as an illness than an offence.

As historians of British psychiatry have observed, certifying physicians were more reluctant to assign 'hereditary' as a cause of illness to 'upper-class and aristocratic patients'.30 This hesitancy is also visible in this study. 'Hereditary' accounted for only 7.2% of assigned physical causes for St John of God's patients and 0.3% for Bloomfeld patients, compared with 53.9% for paying patients sent to district asylums and 38.6% to Stewarts. This hints at the infuence of patients' social status. Degeneracy was largely characterised as a working-class problem, bound up in the belief that the labour value of future workers would be jeopardised by the reproduction and amplifcation of the degenerative effects of the urban, industrial life over the generations.31 By the late nineteenth century, commentators were emphasising the impending social uselessness of the poor and destitute.32 An institution's religious ethos also had implications for the cause of illness attributed. The exceptionally low proportion of Bloomfeld patients assigned 'hereditary' is in keeping with Digby's contention that the managers of the York Retreat were particularly sensitive to this label because of high rates of inter-marriage between members of the Society of Friends.33 Patients' gender, too, was a determinant. 'Hereditary' was cited in 52.5% of women assigned a physical cause compared with only 28.2% of men.

Naturally, causes related to the reproductive cycle, here termed 'biological', were assigned exclusively to women in this study. These causes included 'menstrual', 'child birth', 'puerperal' and 'menopause'. In the British context, Digby has argued that both lay and medical interpretations of Victorian middle-class women's mental illness centred on biological models.34 However, Levine-Clark has suggested that biological symptoms and diagnoses were more often applied to middle-class women, while working-class and pauper women were assigned alternative causative factors.35 Yet, in this study, biological causes were not necessarily assigned to women considered higher in social ranking. For instance, while 11.4% of physical symptoms assigned to women admitted to Stewarts were biological, one-ffth of female paying patients in the Belfast district asylum were similarly described. Furthermore, none of the physical causes attributed to Bloomfeld's middle- and upper-class female patients concerned their reproductive system, suggesting that some certifying physicians accepted biological aetiologies more than others did.

The high proportion of paying patients assigned physical causes reveals that Irish asylum doctors framed much of the illness they observed in these terms. However, subtle differences between aetiological trends for Irish and British non-pauper patients suggest that these causes were not routinely class- or gender-specifc. Although the Irish psychiatric profession had strong professional ties with its British counterpart, including several Irish members of the Medico-Psychological Association36 and Irish participation in the *Journal of Mental Science*, Irish asylum doctors did deviate from the frameworks of their British colleagues. While, as Cox has demonstrated, Irish asylum doctors' explanations for the alleged increase of insanity in Ireland were mostly in line with the British and European intellectual climate, they clearly also drew upon their own personal and cultural understandings of their patient populations.37 These cultural infuences are evident in a heavier reliance on alcohol-related aetiologies in the Irish context. They are also particularly visible in the moral causes assigned, revealing that asylum doctors recognised not only the commonly held physical explanations of insanity, but also the complex socio-economic and personal circumstances which could affect mental health.

Table 5.2 details the most common moral causes assigned to patients in this study. For men, 44.1% of moral causes were work/fnance-related. This category covered wide-ranging factors including overwork and over-study, business worry, anxiety, disappointment and trouble, business and money losses and want of employment, and were more often assigned in urban case studies. While, to some extent, the high proportion of work/fnance-related causes might refect a bias in the case studies in that the majority were Dublin-based asylums, as Chap. 4 discussed, half of the patients admitted to the voluntary and private asylums were not from Dublin. Nonetheless, among male patients in this study, all of the assigned moral causes at Bloomfeld were work/fnance-related ones, compared with only 12.5% in Enniscorthy and 30% in Ennis. Belfast was also particularly high at 64.3%, followed by Stewarts at 55.6%, revealing that business and fnance-related aetiologies were seen to affect a wide socio-economic spectrum, particularly for those in urban contexts.

Women were far more frequently assigned 'domestic' causes, rather than work/fnance related ones. These included domestic trouble, domestic trials, family affairs, family trouble and private trouble and situated woman snugly within the confnes of the domestic sphere. Related causes were grief or bereavement of a family member which had reportedly affected women (17.1% of moral causes) more than men (4.8% of moral causes). The higher proportion of women assigned 'domestic' aetiologies (22.4% of moral causes) compared with men (7.6% of moral causes) reveals that these causes were gendered. Notably, almost onethird of these women were either farmers or had a designated occupation recorded. As will be shown, even when women exhibited anxieties about their businesses or fnancial concerns, these were rarely attributed as causes of their illness.

To what extent, then, did patients' socio-economic background shape the identifcation of their illness? Robert A. Houston has argued that social position was an important determinant and this argument holds equally true for Ireland.38 Patients' former occupation also infuenced the causes attributed to their mental illness, particularly for male patients. Of those assigned moral causes, students were most often assigned 'over study' (80%), while more than three-ffths of those in trade, law or medicine were assigned work/fnance-related causes. Among physical causes, alcohol was most commonly assigned to policemen (59.1%), clergymen (56.7%) and those in trade (55.4%). Alcohol was also believed to have caused the illness of six out of the seven publicans in this study, in keeping with Finnane's contention that a publican's occupation was perceived as a constant source of temptation.39

While we have seen that a myriad of medical and socio-cultural factors, including attitudes towards alcohol consumption, degeneration, gender and social class, infuenced asylum doctors attributing causes, the opinions of patients and their relatives are obscured. The following sections explore medical case notes and the correspondence of patients' relatives and friends to gain a more nuanced appreciation of the lay and medical explanations of mental illness. These sections also examine the interactions between patients and their relatives and friends in accounting for the onset of their illness.

### Urban Economies

During the 1840s, the proprietor of Hampstead House, Dr. John Eustace II, kept a casebook on patients admitted to his private asylum. Although his notetaking coincided with the Great Famine, Eustace did not refer to this cataclysmic event nor to any fnancial hardship afficting the patients he described.40 The most plausible reason for this omission is that Hampstead patients tended to be comfortable or wealthy Dubliners, for whom the consequences of the Famine were less devastating than for other social groups. Eustace's case notes do, however, set the stage for several other themes which emerge strongly in later casebooks for Enniscorthy, Richmond, Stewarts, Bloomfeld, St John of God's, Hampstead and Highfeld. These themes include overwork for men and domestic trouble for women.

Eustace's notes on his male patients are comparable, in some respects, to those compiled by asylum doctors writing in the 1890s. For instance, he wrote of one patient, a John H., that he had 'held a situation in a Brewery where his business required him to remain up all night' resulting in insanity.41 By the 1890s, medical and lay associations between work and mental illness were more pronounced. Suzuki has found that clerks sent to Hanwell in the mid-nineteenth century suffered from fears of losing their positions.42 In this study, between 1868 and 1900 the illness of eight out of the nineteen clerks assigned moral causes was ascribed in the admissions registers to similar anxieties. However, case notes compiled about clerks in the 1890s indicate that several more than this number cited work-related and fnancial anxieties. In addition to fearing loss of their position, some clerks also reportedly suffered from overwork, a cause that Suzuki has argued was usually monopolised by middle-class men and women in mid-nineteenth-century psychiatric discourses.43

Reporting physicians at Richmond were particularly inclined to associate clerks' working life with their illness during the 1890s. Admitted in 1900, James L., a bookkeeper and clerk, was diagnosed with acute melancholia and the assigned cause was unknown. The case notes, however, attributed his illness to 'hard work and study. Little games or amusement of any kind'. James also cited overwork as a cause, believing that 'he let himself get run down and work too hard' and blamed himself: 'thinks that if he had taken a holiday and rest he might have recovered without coming to the Asylum'. The pressures to excel in his profession had clearly taken their toll: 'I had regrets that I had not got on as well as I might have done—as I had intended to get on'. As a result, James feared the loss of his rank and respectability, stating that 'he had an idea that he was going to turn into a low class character and lose his situation—also feared that he might take to drink (though never drank in his life)'.44 Although not a clerk, Thomas B., a melancholic army sergeant, also supposedly fell ill due to clerical responsibilities:

a large amount of work, of an exceptionally worrying and responsible nature, including manipulation of stock to the value of £7000. For two months past this played on his mind, he made errors of calculation; unduly forgot things which he had just done, was very much worried by this, feeling that his mind was breaking down, contemplated suicide very frequently.45

Financial worries continued to trouble Thomas, who later told the medical offcer that 'the prospect of his return to his family with only his pension for support, and his inability to increase the monies by any effort of his causes great depression'.46

These cases mirror the arguments put forward by MacCabe in his 1875 article:

In the competition of the present day the struggle of life is in itself a suffcient strain; and when we remember that, notwithstanding hard work, such a degree of success as would insure freedom from pecuniary care rarely comes to the young professional man, it is highly probable that the *res angusta domi* of the present, combined with the feeling of uncertainty as to the future, favours other conditions constituting a minor form of mental strain.47

MacCabe did not just cite competition as a cause of mental strain, but the nature of work itself:

Sometimes, even with moderate success, if the work imposed is very constant, men of scrupulous temperament suffer from a feeling of morbid anxiety as to the proper discharge of their duties; they take their work too much to heart, and a distressing feeling of being unequal to their responsibilities is very liable to supervene, and to pass into a form of strain that is particularly diffcult to deal with, and that occasionally deepens into a state of mind but little removed from melancholia.48

Both James L. and Thomas B. were apparently plagued with anxieties about their ability to discharge their duties properly. While the case notes suggest that asylum physicians often defned patients' identity in relation to their former occupation, they also imply that relatives and patients placed immense importance on the capacity to work.

Other work-related factors were also said to take their toll. Suzuki has found that patients and relatives expressed resentment or anger towards their employers. He ties this to a working-class 'resentment of aristocratic frivolity' as labouring men were seen to be overworked with little regard for their physical or mental health.49 Richmond paying patients also became embittered with their former employers, although these instances resulted from job loss rather than perceived exploitation, most likely refecting better working conditions for the social cohorts examined in this study. Joseph Patrick O'B., admitted to Richmond in 1891, had worked as an Inland Revenue clerk in London and then Donegal. Following four consecutive periods of three months' leave, he was dismissed permanently, an episode which:

affected him a good deal: At home he is always 'abstracted', will do nothing and has turned against every member of his own family: full of delusions of conspiracy against him on the part of the Inland Revenue Board, his family and 'others' whose identity appears to be indefnite.

Joseph Patrick's disillusionment with the Inland Revenue was so marked that he apparently refused to accept the pension he was offered 'as he said he had a right to stay on in the offce'. Whether this pension was applied to his maintenance is impossible to ascertain, although his fees were £20, suggesting that either Joseph Patrick or his relatives had some source of disposable income.50 Edward S., who had previously worked as a commercial traveller, was also committed to Richmond in 1891. Edward had allegedly been 'an industrious, anxious man generally sober but now and again indulging in "spirits"'. In consequence, Edward's employer had been obliged to dismiss him on more than one occasion but repeatedly reinstated him in periods of recovery due to his 'business capacity'. Ultimately, Edward was dismissed and:

this affected his spirits, and the depression this set off was markedly increased when he failed to get any employment. He then developed such active symptoms that he was confned in Dr Patton's private asylum [Farnham House].

Edward's eventual transfer to Richmond from a more expensive private asylum implies a descent down the social scale. While in Richmond, Edward was maintained at £27 per annum, though he died in the asylum six months after admission.51

The Richmond case notes also record the anxieties of those who had failed to excel in a professional capacity. Edward K., the son of an architect, was committed in 1892. Prior to admission, he had secured employment as solicitor's clerk. However:

his constant mistakes… led to his discharge after about 2 years, and he was then without employment for a considerable time. When he again took work, this time in another solicitor's offce – he failed to give satisfaction, and left his occupation after a row with his employer. Since this time, about 12 months ago – he has been without work, nor has he sought any.52

A more bizarre manifestation of professional failure was David Charles S., who was admitted to Richmond in 1898. As a student, David Charles had been removed from his university due to his 'dislike of the hats of the professors. Whenever he found one lying about he would hide it'. Following this, David was appointed as clerk in the Railway Offce. However, after about two years he was discharged for 'irregularity in his work'. This apparently constituted doing 'anything other clerks told him to do such as standing on his head or going on foolishly'.53

White-collar professionals in voluntary asylums were also identifed as having fallen ill due to their working conditions. In 1891, Joseph McC, a railway clerk, was noted on admission to Bloomfeld to have had 'long hours and irregular meals'. After just four months, Joseph was discharged 'cured' and clearly deemed capable of resuming his occupation: 'left and is to return to business. Is quite well'.54 An inability to work was an important determinant for a patient's admission. As Houston has found, the alleged incapable were judged according to their ability to carry out the tasks required of their occupation or their station in life.55 The same can be said for patients in this study, for whom such incapacity was perceived as evidence of mental illness. For example, Stewarts patient and former offce clerk, Thomas McD B., was admitted in 1889 after he 'became listless and would not occupy himself and was dismissed'.56 In 1896, another clerk, George J., was admitted to Stewarts after he 'became "odd" in manner, fearful of having made mistakes in his books'.57

In addition to those recorded as being unable to work properly, during the last decade of the nineteenth century, several Stewarts patients were admitted expressing business anxieties. Richard M., a tailor, had reportedly been 'brooding over business affairs, cannot settle his mind to any employment although heretofore was a very busy man doing a large trade'.58 Grocer, Charles Alfred M's mental illness was 'said to be induced by adversity in business'.59 Finally, Eli S., a single, Jewish, dental mechanic was admitted to Stewarts suffering from mania. The 'supposed cause' in the admissions register was business disappointment and, in the case notes, business worry. Eli had reportedly been 'bad for about 10 weeks' having 'taken into business with another man in Limerick as dentist and as the partnership turned out a failure he lost all the money he had'.60

In their discussion of work and recreation in the Norfolk Lunatic Asylum, Steven Cherry and Roger Munting have emphasised the importance placed on rehabilitation and self-reliance in the outside world.61 In the Irish context, Cox has found that capacity or willingness to work could predicate a patient's discharge from the asylum.62 In this study, ability to return to work was generally seen as a sign of recovery. The progress of Joshua L.W., a twenty-two-year-old clerk admitted to Bloomfeld in 1895 was clearly measured against his ability to resume employment: 'says he is not well enough to think of leaving or doing any business. Mopes about most of the day'.63 Similarly, Frederick James H. was frst admitted to Stewarts in June 1899, at which point his occupation was recorded as being a mercantile clerk and the cause of his disorder as 'alcohol'. While at Stewarts, Frederick James was eager to return to work. One evening he informed the medical superintendent, Frederick E Rainsford, 'he was off as he had to do stock taking' and the following day urged the doctor to consider that 'Findlater & Co. could not get on without him'. The following month he was allowed home on thirty days' leave of absence, after which he was discharged recovered in October 1899.64 However, in February 1900, Stewarts readmitted Frederick James, now recorded as a bookkeeper. Rainsford wrote that 'since his discharge has kept well and able to attend to business. Says that he was at work up to Monday Feb 19th but he was latterly making mistakes in his books & could not put them right so that on that date his master sent him home'. Frederick James' inability to perform his job seemingly upset him and his diffculties continued at home. The case notes continued:

He is now apparently in a state of active melancholia. Laments his fate. Trembles and weeps. Says he will never be well again and that he is greatly to be pitied. Says his wife treated him badly and that he has not seen her for months.65

Frederick was again discharged cured after just two months in Stewarts.66

There is no record that either private asylum patients or their relatives cited economic failure as a cause of illness. Nevertheless, employment was seen as an important part of their identity and many allegedly evinced an eagerness to resume employment. For instance, Thomas M., a priest admitted to St John of God's in 1899, reportedly 'never ceases to be highly indignant at his enforced detention here, claiming he is still perfectly well able to earn his living if only granted his liberty'.67 The reporting physician, P.O'Connell, placed emphasis on patients' desire or ability to resume employment. In 1885, he wrote of one patient: 'he is now 20 years away from business and evinces no anxiety to return to business. Does this indicate weak-mindedness?'68 Securing employment after discharge, meanwhile, was viewed as a justifcation for discharge.69 In 1900, O'Connell wrote of another patient: 'he is well recovered. A situation has been secured for him'.70

Hampstead patients were less inclined to cite work or fnancial pressures as a cause of illness, or to be attributed these causes.  He threatened suicide but said he had 'not suffcient courage' 'shd have performed the act long ago' 'was not half a man' & c. 'His people would all soon' be dead & c … Refers chiefy to fnancial affairs 'that he is bankrupt', 'has destroyed or will destroy thousands of people', he 'has been an awful fool & sh. have killed himself long ago & c'.72

George's characterisation of his business failures highlights his anxieties about his status as a breadwinner and, in turn, his masculinity. Suzuki has identifed similar anxieties among mid-nineteenth-century London labourers, where male heads of households crumbled under the pressure to provide a stable income for their families. Cox has corroborated Suzuki's fndings that 'medical offcers attributed male anxiety at failing to fulfl gendered economic roles as causes of insanity' such as being able to provide for their families. However, while Suzuki has argued that new working-class notions of manhood were a factor behind 'anxiety-driven cases of madness' and both Cox and Suzuki have focused primarily on pauper asylum populations,73 it is clear that conditions of employment could also trouble wealthier business owners. In his case notes, Eustace recorded the cause of George's illness as 'business and domestic trouble', suggesting that he too believed these factors were responsible for George's breakdown. Although in this study there is little record of wealthier businessmen overtly citing failure to provide for their families as a source of anxiety, these sentiments may have been generally understood or accepted. Certainly, while anxieties concerning the pressure to remain economically productive were evident among the poor, MacCabe highlighted these anxieties among the wealthier classes in language couched in social Darwinism:

It is true that in this contest for civil employment and professional preeminence the 'survival of the fttest' may possibly result; but the struggle itself is, I believe, attended with such serious risk to the mental integrity of the competitors that it occurs to me as not inopportune for this [Medico-Psychological] Association to raise a warning voice against the evil effects of mental strain and overwork.74

At least for male urban populations, evidence exists that there was a very real danger of mental breakdown resulting in committal when an individual could no longer function in an occupational capacity. The comparatively predominant discussions of work and fnance in the Richmond and Stewarts case notes suggests that these anxieties were greater, or at least perceived by asylum physicians as being so, for those lower down the social scale. Patients maintained at lower rates of maintenance were more likely to have experienced fnancial diffculties. It is also plausible that Stewarts' 'middle-class' patient population and white-collar workers in district asylums, anxious to assert their respectability, drew their identity at least in part from their occupations and fnancial prowess. Reporting physicians from similar social backgrounds to these patients probably shared these sentiments. As Suzuki has pointed out, middleclass doctors sympathised with their social peers in their characterisation of them as 'too sincere followers of a rigorous work ethic'.75 MacCabe's emphasis on the wealthy suggests the existence of comparable sympathies in the Irish context.

### Rural Economies

Fears about livelihood and economic productivity were by no means exclusive to urban communities. In rural populations, tensions existed between familial loyalty, marriage and business interests. Many Irish paying patients came from apparently loving familial and spousal relationships. However, these relationships often eroded when land and property interests were at stake. This conforms to commonly held representations of rural Ireland.76 Although historians have emphasised the detrimental impact of issues such as the consolidation of landholdings, emigration, land hunger and Famine memories on emotional familial bonds, which produced families that were 'devoid of emotional gratifcation', Cox has identifed a 'range of familial emotional contexts' among those committed to Enniscorthy and Carlow asylums. This broadly corresponds with Guinnane's contention that rural Irish families shared a strong sense of familial obligation, which extended to encompass celibate farmers.77 Likewise, Oonagh Walsh has demonstrated that at Ballinasloe, families sent letters, querying treatment, offering advice and enclosing food and money for patients.78 In the English context, Melling and Forsythe have noted that the families of pauper patients in Devon frequently visited and demonstrated intense anxiety about their treatment, while MacKenzie has provided a comparable characterisation of the relatives of upper-class and aristocratic patients admitted to Ticehurst.79

The complexity of rural familial relations is particularly visible among the property and business owners in the Enniscorthy asylum. Despite the disproportionate number of single and widowed paying patients, the themes of love and marriage remain dominant in the case notes, providing insight into contemporary concerns regarding courtship and marriage among the non-pauper mentally ill. Intimately linked with these concerns are issues of property and fnancial gain, which also played a decisive role in family relationships and the experience of mental illness. The case of John D. is exemplary. Aged seventy-seven, John was admitted to Enniscorthy in 1891 with 'senile insanity'. Reportedly a 'healthy old man', his personal history was provided by his two sons. The frst symptoms noticed were that he 'wanted to marry a girl of 20, who was a servant to him':

Says if he doesn't marry her his soul is lost and that he'll burn in hell … he is very supple and has often tried to take away across the country to get to this girl … Son says he won't allow bedclothes to be changed or bed made since the girl left, as he says no one can make it but her.80

While in the asylum, the girl visited John in the guise of his niece. Following this, the patient's sons instructed the medical superintendent to prevent any further communication between the girl and their father. They were very much against John's planned marriage, stating that 'she and her family are a designing lot and that they all encourage her to get him to marry her'. One son informed Drapes that 'it is his opinion that his father would have married "anything in petticoats" for the past two years or so'. Allegedly, the girls he proposed to were 'not at all suitable, and "streelish" in appearance and habits'.81

Underlying this narrative were anxieties about John's property. A farmer and a shopkeeper, John certainly had some degree of wealth. His maintenance was £18 per annum and, while in the asylum, he presented Drapes with a further £16 'to keep for him'. On one visit, John's son stated that 'latterly he was not capable of properly doing business in his shop' and elaborated with a description of the confusion this caused among the customers. This portrayal is in keeping with that of the urban professionals and white-collar workers, outlined above. It also supports Houston's fndings concerning the social construction of madness in eighteenth-century Scotland.82 John's sons' motivations for having him committed, however, became apparent when the patient later informed Drapes that 'he gave his sons up his land, but wished to retain his shop himself and get a wife to mind it for him'. John also provided what Drapes termed a 'rational explanation' regarding his romance with the servant girl:

the girl had been so spoken of in connection with him that her character had suffered, and that if he did not make her the only reparation he could by marrying her, he would suffer in the next world.83

Just two months after his committal, John was discharged. Drapes noted that this was 'greatly against the wishes of his sons, but I have not been able to fnd any distinct evidence of his insanity'. According to the census, by 1901, John, now aged eighty-seven, had married a woman of twenty-seven, possibly the servant girl.84 However, ten years later his son resided at John's address with his own wife and six children, suggesting that he had ultimately inherited the property.85 The most plausible reason for this was that John's wife had not borne his children, which would have prevented her from being entitled to property rights following his death.86

This case is important in two respects. Firstly, it highlights contemporary fears among the public about the wrongful confnement of asylum patients for the pecuniary gain of their relatives. That John's sons professed to have committed their father to protect their family business is clear. Whether they actually feared for his mental state is less likely. Secondly, this case demonstrates that in instances where the asylum doctor identifed wrongful committal by relatives, he could and would intervene.

Notably, while this case portrays the public's anticipated behaviour of relatively comfortable landed families, far more evidence can be gleaned of familial love and emotional bonds. For example, James S., a sixty-sixyear-old farmer diagnosed with recurrent mania, informed Drapes: 'I cry all night for my wife and home'.87 Fanny K., on the other hand, 'did not cry or seem affected at all parting with husband' when she was admitted.88 The very fact that Drapes commented on Fanny's behaviour suggests that many other spouses did display an emotional reaction at being separated from their family upon committal to the asylum. Beveridge has found similar in the Scottish context, where patients committed to the Morningside asylum exhibited feelings of despair.89 Like other patient populations, family visits also played an important role in the lives of paying patients in Enniscorthy and, to a lesser extent, Richmond.90 The case notes for several paying patients at Enniscorthy recorded a visit from a least one relative.91

Letters from concerned relatives further corroborate the care and affection they exhibited. When Margaret K. was admitted to Enniscorthy as a paying patient, her husband informed Drapes that 'he would have sent her here long ago but her mother wouldn't allow it'. While she was in the asylum, Margaret's mother Sarah wrote the following letter to Drapes:

I write to ask you how is my child Margaret K. Would you think if she was brought home the change might do her good or cheer her up. She wrote a letter to me a few weeks ago … The frst of her trouble came on from torments this is why she got into a nervous state. I being ill at the time and not able to go to her she was left alone by herself and got into a low state… She asked me to send for her in the letter she wrote me. I sent it to her husband when I got it [sic].92

The 'child', a married woman of thirty, was discharged relieved within two months of the letter's receipt

Yet, in instances where property or business interests were at stake, these factors tended to eclipse those of familial devotion. Indeed, the high numbers of paying patients who had displayed an inability to control their business or function in their profession suggests that this was a major reason for committal. Oonagh Walsh has asserted that people in the west of Ireland would go to great lengths to secure property as it became a measure both of citizenship and stability.93 Yet, with the exception of the case of John D., this study has revealed very little evidence to support this contention. While the extent to which John D. struggled in his shop is diffcult to ascertain, it is conceivable that other relatives' claims regarding patients' incapacity to work were justifed. In these instances, families may have viewed committal as a last resort to protect their resources or livelihood. This is especially true of paying patients in Enniscorthy, whose relatives would have little control over the actions or interactions of a lunatic positioned behind the shop counter or at a farmers' market. As Suzuki has maintained, families in England feared for the lunatic and his or her property as they would be 'easy prey to unscrupulous wretches' in the public sphere.94 This implies that the extent to which wrongful committals occurred may have been exaggerated in the public imagination. As Walsh has argued, many patients with a 'genuine mental illness' accused their relatives of confning them for pecuniary gain.95

Again, mirroring Houston's fndings concerning incapacity to work,96 several paying patients were committed to Enniscorthy following an inability to conduct their affairs. James S., the man who had cried all night for his wife and home, was committed in 1897 because he

Goes out at night and hunts his sheep by the light of a candle and insists on his wife coming with him … He often would go out in pouring rain, and stay about until his clothes were soaked. One night he stayed out (with her) … from 12 to 4am trying to drive sheep into a house they never were in before. Mrs S left him for a few minutes and went into the house thinking he might follow her, but he did not, and when she went out again she found him sitting in a pool of water.97

While in the asylum, James continually wrote to his wife enclosing small presents he had managed to appropriate in the asylum. Drapes listed the gifts he sent, which included 'a ball of yarn', 'a ball of twine', 'a broken head', 'thimbles', 'sweets' and 'tobacco'. Sadly, James was not reunited with his wife, but died in the asylum after a residence of four years, aged about seventy.98

Laurence D. was admitted in 1896 with chronic mania. The frst symptoms noticed were 'sleeplessness' and 'no ability to manage his business'. Like James, Laurence had been 'a good business man in the frst part of his career, but since he began to drink 6 years ago, has failed in capacity for doing any'. Laurence was a family man who clearly had affection for his children. In a letter to a neighbour, Laurence wrote, 'I wish you to inform me how my two dear children are'.99 While in the asylum, Laurence repeatedly insisted upon his sanity and often asked Drapes to re-examine him. Laurence's incapacity, however, appeared to be legitimate:

He had a mania for ordering goods far more than he wanted, then couldn't pay for them, so had to get brother's assistance and in this way was induced to sign this deed … Was very unmanageable at times: used to shut shop door and turn his family out in the street … Memory has been failing: often gave directions twice over, and would mark things in shop over again at prices below what they cost, and would go to customers and tell them they had been overcharged by his wife and brother … he accused [his wife] of 'stealing' goods out of the shop during his absence from home, at the time that his brother William was managing the business … Whereas wife states that she had a perfect right to take anything she required (clothes &c) for her own, or her children's use: and what he referred to was a piece of cashmere, some tablecloths and woollen and cotton goods which she took for that purpose.100

Laurence had managed his business up to three years before he was committed to Enniscorthy. Despite the alleged diffculties and even threats Laurence posed to the family business, it is striking that his relatives cared for him for three years prior to committal. When his family decided he was no longer capable of handling his affairs, a deed was drawn up handing management over to his brother, William. Following this, Laurence visited several solicitors in Dublin but failed to break the deed. When his brother died, his wife, Ellen, took up management of the business and, at the time of Laurence's committal, had been running the shop for six months. Laurence took especial offence to this, complaining to Drapes that his business had been taken out of his hands and mismanaged by his wife. It is unlikely that Ellen would have adopted a managerial position had it not been for her husband's absence, in keeping with Cox's fnding that mental illness could 'disrupt gendered domestic roles and boundaries' and place women in a position of authority in the household.101

In this case, Drapes favoured Laurence's family, and especially his wife. On admission, he was stated to have 'violently assaulted wife on several occasions'. However, Laurence 'denied having ever hurt his wife, but says he did strike her lightly with his foot across her legs, which he had every right legal or divine to do if she did wrong and that he considered she had acted very badly'. Based on his observation of an interview held in the asylum between Laurence, his wife and her brother, Drapes noted that the patient's manner toward her was 'nasty and overbearing, all through adopting the style of a cross-examining lawyer'. Drapes appeared shocked by his patient's behaviour:

At commencement of interview his demeanour towards [brother-in-law] was similar to that towards wife, and in fact he began by ordering him out of the room peremptorily (probably thinking he could bully his wife more easily). This I did not allow. [The brother-in-law] impressed me as an honest, straightforward fellow, patient and good tempered and to have certainly not the slightest hostile feeling towards D: and before the interview was over (after wife had left the room, not feeling well) – D, although knowing that she has been subject to some internal painful affect, in speaking of it as 'that convenient pain that she gets' – the two men were conversing in a quite friendly manner, D calling him Willie and even joking and laughing.

Laurence was discharged on probation after just over a year's residence in the asylum. He was sent in the charge of an attendant to his family home as his wife 'would not send for him, and refused to be responsible for him'. Drapes noted that he had 'conducted himself sensibly here' and the Board ordered his discharge on probation 'on condition that he was not to touch drink, and not meddle with the business'. Drapes' interest in the case continued after discharge, noting four months later: 'heard he went to America and was found dead in his bed at an hotel: Death believed to be due to an overdose of whiskey'.102 This appendage is particularly grim, given the man's affectionate references to his daughters while in the asylum and it suggests that, although discharged, the former patient failed to put down roots following emigration. Four years later, Laurence's widow Ellen was listed in the census as a draper and 'head of family', living with one daughter and a draper's assistant, apprentice and manager. By 1911, Ellen had retired and lived with her two daughters who had both become governesses.103

In addition to tradesmen, several farmers admitted to Enniscorthy referred to the unfavourable state of their fnancial affairs. The frst symptoms of illness noticed in Martin B, a cattle dealer, shopkeeper and farmer, were that he 'got notice to leave his home, took this to heart thinking he wouldn't get another'.104 Fear of eviction or the state of one's farm reportedly dominated some patients' thoughts. Like female patients in Enniscorthy and neighbouring Carlow,105 Marcella J. expressed severe anxieties regarding her status as a paying patient, becoming 'rather agitated now as a rule: thinks all her money is gone: that we are running up a big bill against her here which she will never be able to pay'. A few days later she got 'depressed and agitated: has no money: no use my writing a bill against her' until fnally she became 'very agitated: keeps crying out: "I can't I can't: I've no money, no money at all"'. The primary cause for Marcella's apprehensions might be that, on admission, she had delusions that 'the cattle on the land have been burned'.106 In the case of Francis R., who owned a farm of 110 acres, the economic hardships he experienced were attributed to his mental breakdown:

He has been farming for past 10 years or so, but did not know very much about it as he lived at home up till then (father was sessional crown solicitor … now retired) … Found it hard enough … that it did not pay and added that was what sent him in here.107

It is therefore plausible that, for some, the impact of the agricultural hardship which continued into the early 1890s may have contributed to or been exacerbated by mental illness. Even later in the century, these issues were referred to. As late as 1899, 'the only cause' of illness that the sister of paying patient, Kate K., could give Drapes was that 'they lost a grass farm and this appeared to prey on her mind'.108

For landlords, excessive spending or even charity were viewed as indications of illness. John Neilson Eustace wrote of Henry O.B.:

His philanthropy is excessive, some beggars in the village have their rents paid by him, all the children look to him for pence, a pedlar used to receive 2/6 a visit & was told by him not to come more than once a month. Needless to say, during the man's lifetime he came as often as he sd. An att who married & left for Australia asked for some money & was lent £80 & given £10. This appeared at the time & has since found (I believe) to be an exceedingly bad investment.109

Similarly, 'gentleman' patient, George Leslie K reportedly:

gave away a great deal of property to his tenants & on the Lord Chancellor taking care of his estates he extorted money to the extent of £600 from his wife in order 'to buy more property for the poor tenants'. The money was kept in his trousers pocket & he always slept with this garment under his pillow.110

These narratives, most likely supplied by relatives, once again highlight the importance placed on land in rural communities. Like the paying patients admitted to Enniscorthy, failure to properly conduct property or business interests eclipsed family ties resulting in committal.

The infux of paying patients with property and business interests into district asylums like Enniscorthy supplied asylum doctors with new challenges. In many ways, the doctor was cast in the role of judge or mediator between family members, as they attempted to uncover the motivations behind individual committals.111 Drapes appeared to embrace this role as he endeavoured to get to the bottom of complex familial conficts. This could work in favour of the patient or the committing party, depending on the facts he accumulated, and did not appear to be gender-based. While many families exhibited affection and care for their mentally ill relatives, the outcome for patients who had ceased to conduct the family business effciently was usually bleak.

# Policemen, Violence and Alcohol

Like white-collar workers, another group whose conditions of employment were seen to affect their mental health negatively was members of the police force. The private lives of Royal Irish Constabulary (RIC) men were often subject to intense scrutiny, due to the wide-ranging codes of regulations imposed on them. When a policeman married, he was forbidden from serving in his wife's native county, meaning that marriage was a major cause of transfer within the RIC.112 Several policemen admitted to Enniscorthy as paying patients had been forced to live separately from their wives. In February 1895, William H., aged 36, married Margaret in Tipperary. Margaret remained there for fve months before her husband asked her to join him in Enniscorthy. Their cohabitation was cut short just eleven days later when William's station was changed and 'he said there was no accommodation for her'. Enforced separation from a spouse was also assigned as a cause of illness, implying that at least a degree of spousal affection had existed. Bernard C., an RIC constable and paying patient at Enniscorthy had moved '2 years ago from Ballywilliam where his wife resides: felt this separation a good deal and attributes this state of his mind to this'.113

The pressures of a position in the RIC also affected the wives of policemen. When Anne McC. was admitted to Richmond in 1892, she said she had not seen her husband, a detective inspector in the RIC, for about ten years. Prior to this, she had travelled around with him before being committed to Stewarts asylum and eventually transferred to Richmond. Anne stated she did 'not know exactly who sent her here [Richmond], if her children, they must have been instigated to do so by the constabulary or the Lord Lieutenant'. She later reiterated that 'the constabulary must be the cause of all her suffering'.114

The personal histories of paying patients from the police force, sometimes admitted as dangerous lunatics, are characterised by violence and make for vibrant, although at times disturbing, accounts of the lives of mentally ill Irish policemen. During their short time together, William H. exhibited numerous signs of violence towards his new wife. On admission, it is recorded that he threatened to shoot her and 'once took a knife and made the movement of sharpening it, and when she asked him what he was doing that for he said, "oh, for business"'.115 Perhaps more harrowing, however, is the case of Sergeant K. The sergeant, a forty-four-year-old married policeman, was admitted to Enniscorthy as a dangerous lunatic in April 1897, before being named a paying patient. The warrant stated that he had attempted 'to locate a revolver' with the intention of killing a bird 'that was annoying him', as well as threatening to shoot the head constable. When his wife, Mary Jane, a ladies' nurse in Dublin, came to visit him, he 'received her affectionately', kissed her and they walked in the grounds together. However, Mary Jane informed Drapes of her husband's history of violence, from which he compiled the following:

They are 17 years married. Was only 4 days married when he threatened to kill her. Before he was married he beat her when in drink. About 3 years ago wife spoke to him about the company he was keeping, and he tried to kill her with a hatchet … tried to smother wife 2 years ago in the night and she got up and left him fnally … She has often to rush out of the house in her night-dress.116

Just four months after his admission, Sergeant K. was discharged 'recovered'. Yet, the family's relationship with the asylum and Drapes did not end there. A newspaper clipping from an unidentifed source was appended to the case notes, detailing the man's disappearance. Sergeant K.'s whereabouts was eventually detected and his wife wrote to Drapes in desperation:

#### Dear Sir,

The old trouble has come to me again. What I am to do with my husband I do not know … On discharge he disappeared and for ages I knew nothing of him. Now he comes to the house and swears he will murder me … I dare not sleep at night fearing my life, the hatchet as his constant companion.117

In Richmond, policemen were frequently associated with violence. John K. reportedly 'took up a poker to his daughter', while the warrant for Edward B., a pensioner from the Dublin Metropolitan Police, stated that he 'did assault his wife'.118 So apparently ingrained was violence among the police force, that police constable Peter C., who was not violent, believed he would never be ft to return to duty 'as any fghting or drunken row affects his nerves very much and "makes him all a tremor"'.119

The ties between policemen and violence are especially signifcant, given their role in law enforcement. However, the high social status afforded to this group was undermined by their unruly behaviour, causing public scandals and spectacles. Mary Jane K. was shocked by the erosion of her husband's social values and struggled to come to terms with her plight. The remainder of her letter to Drapes read: 'I gave him a good home and he had not anything to do except keep respectable, live honestly and off he has gone … Pardon my troubling you so much. Yours, Nurse K.'

Recognition by asylum doctors of the high levels of violence these men displayed towards their wives complicates McCarthy's contention that 'male violence against women and children was hidden and condoned' by the state and that female victims of domestic violence were often committed to Enniscorthy in the early twentieth century.120 In addition to violence, 'excess of alcohol' was frequently given as a cause of insanity for policemen in this study, as outlined above. Like other patients assigned this cause, policemen stayed for a relatively short period of time in the asylum; almost 70% were discharged before six months and 84.6% before twelve months. The case of Michael D., a thirty-fveyear-old, single, RIC constable who was admitted to Enniscorthy in 1897 with *mania a potu* was typical:

Seems always nervous, hands trembling and voice hesitating. Denied that he drank much, says the police are mostly blackguards and told lies of him … Admits he has a bad record in the police, but attributes it to false charges against him, and his nervous manner being attributed to drink.121

Michael was discharged recovered after just one month in the asylum. Seeing as several of the policemen who were dismissed from the force were allowed to re-join,122 it is conceivable that patients in this study might be permitted to do so following recovery. Certainly, Sergeant K., who had been in the police force for twenty-fve years when committed, told Drapes he was 'once punished for drink when he had been 8 years in the force but never since'.123

### Women, Work and Domesticity

Links between conditions of employment and mental illness were far more tenuous for female patients in this study. Eustace II's notes on women admitted to Hampstead in the 1840s reveal an early medical alignment of women's mental illness with failure to fulfl domestic duties.124 Anna Maria D. was admitted to Hampstead in 1845, after she 'became gloomy and reserved and neglected her husband and children, desiring to be alone'.125 This behaviour continued while Anna Maria was at Hampstead and Eustace recorded: 'some of her family have called to see her, their visits have not improved her. She received them unkindly'.126 In the same year, Helen B., who railed 'very much against her husband & threatens him very much', was admitted with 'habitual intoxication'. Her husband informed Eustace that 'in consequence of her conduct to him he has not slept with her for two years'.127 While commentary on a woman's failure to fulfl conjugal duties was obviously confned to married women, single women were expected to behave appropriately towards family members, especially when they relied on them for fnancial support. Refusal to do so was also viewed as a sign of illness. In 1846, Eustace II reported that Florinda C.'s monomania was 'manifested in the most violent dislike to her brother where kindness to her had been for years her almost sole support'.128 Almost half a century later, Drapes wrote of Catherine S., a paying patient in Enniscorthy: 'husband states that her mind began to be affected about ? months. Has done no work in the house since then (except a little knitting)'.129

As Chap. 3 discussed, the relatives of Ennis patients who were called upon to contribute towards maintenance frequently referred to their straitened circumstances. Family friends, writing in support of these claims, also blamed female 'domestic trouble' for mental illness. In 1889, James Frost JP wrote to Gelston concerning the fnancial condition of a potential patient's husband:

A neighbour of mine, Mrs G[-] of Ballymorris has become insane and she must be placed in the Lunatic Asylum. As to the capacity of her husband to pay for her while she remains an inmate, I would say it is very slight. He holds about thirty acres of land, and has a few cows, but he is up to his ears in debt. He owes two years rent, and I do not see him to possess any adequate means to meet the payment of it. For a long time past, he was not even able to pay the wages of a maid servant and his poor wife had to do all the work of the house besides taking care of the children.130

Richard Studdert, a governor of Ennis asylum, also wrote to Gelston concerning Mrs. G.:

she seems to have been respectably brought up and educated and was doing well until a sad succession of misfortune came upon her – 5 of her 9 children having died within a few weeks, also her father in law at the same time a hitherto comfortable man became quite otherwise from reduced circumstances. All resulted in her going out of her mind.131

These representations succeeded in convincing the Ennis asylum board to admit Mrs. G. as a pauper patient.132 Ten year later, a parish priest, James Cahir, wrote to Gelston about the fnancial affairs of another female patient, Mrs. K. According to Cahir, twenty-three years earlier, Mrs. K.'s husband:

owing to money diffculties left his family and went to America where I believe he is still living although he never writes home. When he left, his stock was reduced to one cow and his poor wife in struggling to maintain herself and three young children was so worried by diffculties that she lost her senses and had to be sent to the Asylum leaving only one cow on the farm and rent in arrears.133

In this case payment was also 'remitted'.

These letters reveal lay interpretations of factors which precipitated female mental illness. Those writing in support of patients' families pinpointed fnancial decline resulting in increased housework, childcare, farming duties and family bereavement as the cause of their illness. These lay opinions differed from those asserted by Eustace II in the 1840s and Drapes in the 1890s; while failure to perform domestic duties was viewed as a *symptom* of mental illness by medical observers, increased domestic duties and 'domestic trouble' were characterised as a *cause* of illness in lay explanations.

'Domestic trouble' also reportedly featured for women in paid work. Several female patients admitted to Stewarts exhibited fears about their fnancial condition and their family businesses. Ann Elizabeth Ellen M. had allegedly 'suffered great domestic trouble thro' bankruptcy of her husband' and the cause of her illness was attributed to adverse circumstances.134 Jane D., whose husband was a butcher with a shop on Moore Street in Dublin City, 'was associated with her husband … in business and as such was kept a good deal indoors … got very silent and fretted a good deal about business wh. was then dull. Slept badly'. The 'supposed cause' of Jane's illness was not 'business worry' but 'domestic bereavement', suggesting her role in the business was considered domestic rather than commercial. This was refected in the admissions register, where her occupation was recorded as 'butcher's wife'. When she recovered, Jane's husband clearly appreciated that she needed a rest from the butcher's shop and took her home 'with a view to sending her to the seaside'.135 Even when female patients had a designated occupation, such as Eliza Jane K., a single woman and shopkeeper who was 'greatly concerned about money matters', or Elizabeth Jane M., a married draper, who had 'had great business anxiety thro' boycotting', business worry was not cited as a cause of their illness.136 Instead, Eliza Jane was assigned no cause and Elizabeth Jane was assigned 'hereditary'. Disparities between male and female aetiologies most likely stem from contemporary attitudes towards women's work. From the midnineteenth century, offcial interpretations of productive labour shifted and infuenced how women's occupations were enumerated in the census returns. By 1871, married women who worked with their husbands and single women who engaged with the family business were classifed as being in domestic occupation.137 It is plausible that asylum physicians were likewise inclined to characterise female business concerns as domestic rather than commercial.

Although not engaged in commercial work, women in wealthier households played a signifcant role in maintaining the household budget, deciding where to shop and seeking credit.138 Accordingly, women committed to Highfeld were sometimes measured against these functions. Like men who were deemed ft to resume employment, female paying patients who demonstrated an ability to resume domestic roles were seen as improved. John Neilson Eustace wrote of Margaret W., a sixty-year-old widow with no recorded occupation, 'she is a capable business woman & frequently goes into town shopping'.139 Eustace clearly viewed Margaret's ability to shop as a sign of improvement. On the other hand, an inability to manage one's fnancial affairs could be viewed as evidence of insanity. Emily H., who was maintained at Stewarts at £50 per annum, was 'said to have had grandiose ideas and that she went into Arnotts [department store] and bought £40 worth of goods'.140

### Conclusions

Historians have been curiously reluctant to emphasise the importance asylum doctors placed on patients' working life prior to committal and the potential this had to cause mental illness.141 This chapter has argued that greater historiographical signifcance should be accorded to factors such as alcohol, employment, and fnancial and domestic troubles in the aetiologies attributed to fee-paying patients. In this study, both lay and medical commentators commonly recognised these factors as having triggered mental illness in paying patients. Like labouring men in Victorian London,142 urban life reportedly held challenges for Irishmen who fell prey to the anxieties generated by employment within the commercial sector. The working life of certain occupational groups, including clerks, was often identifed as precipitating insanity. Policemen were another group whose working conditions attracted psychiatric attention. Subjected to an extremely regimented lifestyle, RIC men suffered marital problems and displayed a tendency towards alcohol abuse and violence, resulting in committal. This association between working life and insanity speaks volumes about contemporary society's interpretations. In relation to social status, those unable to maintain their position within a given occupation were defned in terms of this failure.

Both Cox and Oonagh Walsh have emphasised the presence of familial bonds in the rural south-east and west of Ireland respectively.143 This chapter has revealed that, among paying patients, land disputes and an inability to manage one's affairs threatened to shatter these bonds, often resulting in committal. Discussion of women's reproductive functions did not tend to occupy lay or medical narratives of female insanity in this study. Instead, patients, their relatives and their doctors discussed the mental strain of domestic circumstances, which could even include business anxieties. That domestic causes were often applied to female mental illness in place of work/fnance is to be expected, given contemporary understandings of productive employment and female occupations. Nonetheless, lay explanations of female illness indicate awareness and even appreciation of the potential strain—both domestic and economic—of women's work in late nineteenth-century Ireland.

### Notes

and one of the few Irish asylum superintendents who published on the causes of mental illness in Ireland. See Cox (2010, pp. 281–282). For more on Drapes' career, see Kelly (2016, pp. 93–96).

### References

Daly, Mary E. *Women and Work in Ireland.* Dundalk: Dundalgan Press, 1997.

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# 'A Great Source of Amusement': Work Therapy and Recreation

Psychiatry's emphasis on employment went beyond assigning causes of illness to encompass treatment. Work therapy was a key facet of moral treatment, which remained a dominant form of therapy in nineteenth-century asylums. Asylum doctors stressed the usefulness of work therapy for patients, including distraction from their malady, rehabilitation and their eventual resocialisation following discharge.1 However, by the 1860s, asylum doctors' optimism about moral treatment was gradually replaced by a therapeutic pessimism.2 The benefts of moral therapy were most famously expounded by Samuel Tuke, in his *Description of the Retreat* published in 1813.3 These included the distraction of patients from painful or disturbing thoughts through providing them with occupations and pastimes. The York Retreat's therapists believed that the proper regulation of the mind was connected with disease prevention and. stemming from this, work therapy was intended to 'encourage the growth of mental abilities and especially the power of concentration'.4 This refected the infuence of the Society of Friends' discipline on the Retreat's therapists, which aimed to inculcate habits of Christian self-denial, moderation and uprightness of character in its youngest members.5 In the absence of these habits, patients were provided with a domestic setting, in the form of the York Retreat, where they could be resocialised.6

Unsurprisingly, for women in this study, work therapy was exclusively confned to domestic occupations, further underscoring a gender bias in Irish non-pauper asylum care. In voluntary and private asylums, doctors counteracted the diffculties they faced in delivering appropriate work therapy for wealthier patients by offering more varied and stimulating recreations.

<sup>©</sup> The Author(s) 2018 A. Mauger, *The Cost of Insanity in Nineteenth-Century Ireland*, Mental Health in Historical Perspective, https://doi.org/10.1007/978-3-319-65244-3\_6

### Productive Employment

In Irish district asylums, as elsewhere, work was considered essential as a therapeutic regime and fundamental to Victorian concepts of respectability. In Ireland, asylum medical staff perceived patients' failure to work as a 'refusal to join the ranks of the "respectable" poor'.7 A number of the doctors in this study clearly subscribed to the therapeutic benefts of occupation and recreation. However, they often struggled to fnd suitable employment for their wealthier patients. This was not a uniquely Irish problem. Digby has noted the diffculty in employing private patients at the York Retreat, contending that resistance to manual labour stemmed from a perception that it was menial and degrading. She has also highlighted the problem of 'matching possible work to previous life habits' for this social cohort, a pursuit which was vital to the provision of moral treatment.8 Nevertheless, asylums could provide outlets for skilled and semi-skilled workers. For instance, at Staffordshire asylum in England, male paying patients who were tailors and shoemakers occupied themselves at these trades.9 In Irish district asylums, employment was as much part of asylum life for paying patients as their pauper counterparts and many were given work that was related to their former occupation. The degree to which individual paying patients were willing to engage in work varied a great deal. Some reportedly did no work, a point which was frequently noted by the reporting physician. However, there is no evidence that paying patients who refused to work in district asylums did so due to a sense of social superiority.

Physical labour was considered an especially appropriate tenet of moral treatment in Ireland due to the large numbers of agricultural labourers in the asylum population,10 and several paying patients who were previously farmers worked on the asylum farm. Other patients deemed physically ft, such as soldiers, were sent to work on the farm in Richmond. In Britain, work therapy has been attributed to an ethos of political economy in asylums, making savings on maintenance costs and staffng, especially where asylums were understaffed, to accomplish a degree of institutional self-suffciency.11 At the Norfolk asylum, food was produced directly, using patients' labour on the gardens and farm.12

Paying patients in this study often contributed to the economy of the asylum, performing tasks at which they were skilled. For example, at Enniscorthy, Harvey Henry M., a boot and shoe shopkeeper, was reportedly 'very fond of polishing boots' and asked the attendants to allow him to polish theirs.13 When William Henry P., previously a carpenter, broke a window sash while trying to escape, he was employed at fxing it 'and being a carpenter he had no diffculty in mending window'. Following this, William Henry asked Drapes to allow him to work and was sent to the carpenter's shop where he 'worked steadily'.14 Ellen W., who had been '6 years in America as waitress in a hotel', was sent to work in the kitchen, and Teresa C., a tailor's wife, did 'a little needle-work'.15 John B., a painter suffering from acquired epilepsy, was 'put to work at painting during this month and he kept fairly well at it, but has to stop at times if he has had a ft'.16 At Richmond, Francis F., a porter, was 'retained as a ward worker in hospital'.17 Christopher O'K., a painter, was employed at painting and 'working with the farm gang', while Thomas G., a civil service pensioner, worked as a clerk.18 These examples clearly illustrate that paying patients, a number of whom were skilled, could be employed advantageously by the asylum, which benefted from the infux of skilled workers, capable of painting, mending and crafting as the authorities desired. Furthermore, working in familiar areas could be considered therapeutic and even rehabilitative for patients, putting them on a road to recovery and fostering self-reliance outside the asylum.19

Work therapy was manifestly seen as rehabilitative at St John of God's, where its medical superintendent, O'Connell, noted frequently when patients performed tasks linked to their former occupations. For instance, O'Connell recorded that patient Daniel C., a priest, 'read at least part of the divine offce' almost daily. However, he 'still absents himself from chapel' and was 'at times, cranky and quarrelsome as well as insulting to his fellow priests … he has been somewhat more disagreeable to his fellow priests, in their special sitting-room, during the winter'.20 Eventually he was 'left much to himself in the priests' sitting-room where he has no one with whom to quarrel' until ultimately the priests' sitting room was described as 'the special room formerly set apart for priests'.21 James C., a lay brother, was more devout: 'he frequents the chapel as usual … never forgets to go to chapel privately, every day after dinner'.22 Another priest, Patrick B., reportedly often attempted to give sermons, saying that he was 'a most elegant preacher'. When asked to preach, Patrick would 'say something and repeat it several times, giggling at his own words'.23 O'Connell's motivation for recording such information can be inferred from his notes on patient Michael K., a farmer:

He takes much interest in cattle and horses of which he is a very good judge… He is easily roused from these thoughts to take him to a fair or market to buy or sell cattle is suffcient… While there is any excitement for him, as the recent Horse Show, at Ballsbridge, which he delights to visit, or a race at Leopardstown, he is in excellent spirits. He takes keen delight in farming affairs of all kinds and is thoroughly skilled at all that pertains to agriculture… If he can engage from time to time in anything pertaining to farming it acts as a great stimulus to rouse him and to keep him from thinking of himself – from interpretation… I often fancy that if he had constant mental occupation, such as his farm must give, he could take care of himself and do his business well.24

This extract suggests that O'Connell considered employment a worthy means of distraction for his patients. O'Connell also viewed lack of work as problematic, writing of Louis de L.V.W., who was admitted in 1885: 'no mental change except that he is rather stupid and sleepy, due, no doubt, to not being employed'.25 This was not confned to fee-paying patients. Medical staff in district asylums found any resistance to work in the asylum particularly troubling, interpreting such refusals as symptoms of continuing poor mental condition.26

Although they stressed the importance of useful work, district asylum doctors did not force paying patients to stick to one form of employment, especially when they did not appear to enjoy or excel at it. James L., was therefore allowed to give up weaving 'because he disliked noise of looms' and was moved to gardening.27 A sixteen-year-old schoolboy, Charles L., worked in several areas during his patient career including the tailor's shop, the smith's shop, the shoemaker's shop, the weaving shop, the bookshop and the farm. He was also employed at driving one of the carts.28

Voluntary and private asylum patients were accorded relatively few opportunities to work, as asylum staff found it hard to provide class appropriate employment. As early as the 1830s, Bloomfeld's managing committee commented on the 'diffculty of fnding employment or amusement as would be benefcial to the patients' and issued an appeal to the asylum's subscribers for any suggestions they might have.29 The issue of how best to employ patients continued to daunt the committee. In the same decade, they noted that one patient had been removed to 'another asylum, where greater facilities were afforded for agricultural employments, which it was hoped might in his case be attended with advantage'.30 In 1850, Bloomfeld's managing committee was pleased to report that 'in the course of the past year the manifest beneft arising from out-door employment, and the steady improvement in the order and discipline of the house which has kept pace with the introduction of means to amuse and employ, have been very gratifying'.31 'Employments of an industrial character, together with suitable recreations, and an enlarged supply of newspapers, periodicals, and useful and entertaining books' were not only credited with rendering Bloomfeld's patients more comfortable and having 'fostered habits of self-control and propriety of demeanour' but also with contributing to the 'improvement of their bodily health'.32

Predictably, the committee noted that several male patients were employed in the garden and grounds, while female patients tended to perform fancywork and needlework.33 This is corroborated in the house steward's casebook for this period, where he documented many male patients assisting the gardener, sweeping up leaves in the shrubbery, moulding cabbages, painting and undertaking 'trellis work'. Others raked and trimmed the walks in the ladies' feld, pumped water, chopped wood and helped in the laundry.34 As with paying patients in district asylums, while those at Bloomfeld were actively encouraged to engage where possible, they were not confned to one occupation and clearly had at least a measure of freedom in how they spent their time. One patient, David S., reportedly 'adopted the coachman as he own' and stated his intention to retain his services when he left the institution. In the meantime, he performed various jobs to assist the coachman. The following week he was found busy in the garden, 'with the idea that it was assisting the groom'.35 The employment of male patients in the vegetable garden hints at the ethos of economy and self-suffciency outlined earlier. Nonetheless, as will be seen, far more attention was paid to occupying Bloomfeld patients at recreational pursuits, suggesting that distraction rather than economy was the principal regime for patients at this asylum.

Despite improvements in providing occupational therapy during this period, Bloomfeld's managing committee was still concerned with how best to occupy patients. Bloomfeld's visiting physician, Dr. Valentine Duke, wrote in his 1863 report of his diffculties in engaging patients in employment, which he argued were 'increased rather than diminished, as the patient occupies a higher position in the social scale'.36 In later reports, Duke juxtaposed the industry witnessed in district asylums with the relatively poor output of Bloomfeld's patients:

In those Asylums intended specially for the accommodation of the working classes, the entire range of manual and mechanical employment can be called into aid, but with us these are scarcely, if at all available: a little carpentry, some painting and working in the garden and grounds, being all we can adopt.37

Duke elaborated the following year:

For farming or other rural employment our resources are but limited, and the general sphere of life, and antecedents of the greater number of our patients, would render mere manual labour an unsuitable and inadequate occupation. We must therefore seek other resources.38

In fact, in that year, two patients had angrily objected to the notion that they might assist in the garden moulding cabbage plants. When Stanley asked Joseph R., to do so, Joseph retorted that 'he was not of that trade and wouldn't do anything of the kind'.39 A month later, Stanley asked former grocer David S., to perform the same task and 'at frst he declined saying his dignity would be reduced if seen in my [Stanley's] company'. However, he eventually agreed to work in the garden, albeit for 'a short time'.40 This mirrors the behaviour of non-pauper patients at the Morningside asylum in Scotland, where a sense of social superiority was common and posed challenges for asylum authorities.41

By the 1890s, Stewarts' managing committee was also commenting on the complexities they faced in this regard. This committee, however, did not appear worried, reporting that 'an excellent dietary, pure air, cheerful associations, and such entertainment as can be provided … are powerful factors in bringing about recoveries'.42 Case notes for Stewarts' patients contain few specifc examples of patients actually carrying out work. As was the norm for patients in nineteenth-century asylums, those who did work were employed largely in line with traditional gender roles.43 Reports of female employment detailed needlework, sewing and 'household work',44 though these occupations might equally be deemed as recreational activities for wealthier female patients. For example, at Staffordshire asylum in England, frst-class women 'knitted and sewed for pleasure' rather than work.45 Stewarts' medical superintendent, Frederick E. Rainsford, stressed the gendered divisions of patient labour when he wrote of Eliza Edith A., making 'senseless requests such as being allowed to work on the farm'.46 Like patients in Enniscorthy and Carlow,47 Stewarts' patients also engaged in housework.48 However, male patients employed indoors tended to undertake 'masculine' activities such as working with the carpenter, in the engine room at 'various mechanical works' or raking gravel. Notably, patients carrying out these jobs were paying lower fees of £50 or £60 per annum, suggesting that those who paid higher rates were not expected to carry out manual labour.49 It is highly unlikely that wealthier patients who did not work in civilian life were employed in asylums.50

This is corroborated by an exploration of the case notes for Hampstead and Highfeld patients. There is no record whatsoever of Hampstead's exclusively male patients carrying out any work. Similarly, Highfeld's all-female patient population seemed to engage in very little housework. While Lucy D., 'did some serving', she reportedly showed 'very little enthusiasm for her work'.51 Another patient, Kate L., 'did some needlework' and was 'useful in the house and garden' but she also 'read steadily' and was able 'to play a good game of whist'.52 Yet, at the less expensive St John of God's, patients were strongly encouraged to work. Several worked in the laundry, the poultry yard, the linen room, peeled fruit and vegetables in the kitchen, cleaned and dusted the 'cells', the refectory and the 'agitated division' and one patient polished his boots, a task which he reportedly insisted on doing himself.53 Michael D. was said to be outstandingly helpful and assisted in looking after his fellow patients:

is always most willing to do light jobs of work and to assist old and feeble patients… he always dusts the furniture in the day-room after the foor has been swept… He makes himself useful especially in leading Mr G to and from the refectory etc… He also goes to the agitated division at times to play the piano for the patients in it.54

These accounts suggest that the patients in St John of God's were willing to assist in the running of the asylum. One patient, Joseph H., was 'perpetually insisting on looking for work and will steal away to some part of the House and fuss there. When not given work to do, he will go out in the garden and fst up grass blades growing in the walks'.55 The relatively industrious characters of Richmond and Enniscorthy district asylums and St John of God's, compared with Bloomfeld, Hampstead and Highfeld, suggest that work therapy was very much an occupation for less wealthy asylum patients.

# Recreational Activities

Given the strong emphasis on productive occupation in the district asylums, it is, perhaps, unsurprising that paying patients there had less time to engage in amusements. Recreational pursuits in district asylums were often limited as overcrowding resulted in the conversion of dayrooms and exercise yards into dormitories.56 In relation to recreational activities, there are very few accounts of district asylum paying patients doing anything more than reading or playing cards.57 At Richmond, there is an isolated reference to one female paying patient playing the piano.58 While another patient, Frances N., would 'do no work of any kind', when she informed a medical offcer that she had won prizes for some of her paintings at various exhibitions, she was 'supplied with paints & c but she is unable to fx her attention so as to produce a picture. What she paints one day she spoils it the next'.59 In addition, the hospital grounds at Richmond were open to patients every day and sports, picnics and entertainments were sometimes organised.

In more expensive asylums, patients were encouraged to occupy themselves in a wide range of amusements and entertainments. Comparably wide-ranging activities were on offer to patients at the Crichton Royal Asylum in Dumfries, where the superintendent, William Alexander Francis Browne (1837–1857), 'devoted enormous energy and ingenuity to the moral discipline and treatment of his charges'. Browne was concerned with restoring his well-to-do patients to sanity and later confessed that activities such as these combated the monotony of asylum life.60 Annual reports and case notes for Bloomfeld and Stewarts patients abound with evidence that recreation, rather than work, was considered a vital part of the therapeutic regime in voluntary asylums. In 1863, Duke alluded to the reasoning behind this. While he highlighted the diffculties inherent in fnding socially appropriate employment for Bloomfeld's patients, Duke opined that:

It is not possible to compel the mind which has been educated, and accustomed to activity either to rest completely, or remain idle. Mental repose cannot be insisted on, there is no forcing the intellectual faculties to lie fallow.

Duke therefore stressed the importance of creating suffcient 'diversion of thought, and to secure a healthy interest in surrounding objects'. He counted among the most useful 'party evenings', when patients could 'enter into the spirit of the scene, enjoying the presence of strangers, performances of music, acting of characters, &c.' and pronounced himself gratifed 'to think that their happiness is even temporarily prompted by inducing a forgetfulness of self'.61 Party evenings, dances and other evening entertainments became a frequent element of voluntary and private asylum life. However, the gaiety of such evenings could be disrupted by patients, as is evidenced by the report on St John of God's patient, Richard A.P., who, at an evening entertainment, became 'quite excited' and required 'four men to remove him from the recreation hall'.62

From the 1880s, Pim detailed the recreations on offer at Stewarts, which were promoted in the asylum's annual report. These included the availability of daily papers, books from a lending library, books and periodicals donated 'from some of our kind friends', a billiard table which was 'a great source of amusement to those who can play' and a piano 'for the ladies, many of whom are very good performers'.63 The woods and pleasure grounds were continuously being enlarged and additional walks were constructed by male former pupils of the imbecile branch, who were engaged in gathering fallen leaves and digging.64 In the summer of 1898, Stewarts organised carriage drives for patients to 'places of interest'.65 During the winter months, various forms of indoor entertainment were adopted, including 'magic lantern exhibitions, conjuring, cinematography, Punch and Judy, Concerts, & c'.66 Stewarts' managing committee was keen to point out the benefts of the asylum's small population and attractive location. Overcrowding was guarded against, while the grounds were said to be 'fully taken advantage of for recreative [sic] purposes'.67

Physicians writing case notes on Stewarts' patients in the 1890s took care to note the sorts of amusements they enjoyed. Frederick James H., took an 'interest in books and reads a good deal', while Maude Frances C., could 'enjoy a dance'.68 H.P., an architect, 'employed himself making architectural drawings and worked with neatness and precision'.69 Several attempts were also made to occupy patient Henry Richard Q., a professor of music. In the asylum, he played his 'harmonium a little'. Sadly, however, the professor, who had been diagnosed with 'senile decay', was unable to enjoy his music:

Tried American Organ in Dining Hall yesterday but could make very little of it owing to the weak state of his legs being unable to work the bellows … Attends Divine Service, attempts to sing gets out of time and loses his place.70

During the 1890s, Bloomfeld's patients were kept busy with games, outings, visits, reading and various other amusements. Among references to amusement in the case notes, Joshua L.W., was allowed to take 'tea in the parlour with his sisters', William G., 'reads the papers, plays chess, ball, croquet, and such like' and Henry Jacob H., spent 'a good deal of time painting or drawing various things about the place'.71 Patients also went out for drives, played billiards, walked in the garden, smoked, played the piano, read books, spent a month at the seaside, sewed, knitted and played 'Haluna'.72

Patient amusements at St John of God's were less varied. In this asylum, patients read newspapers, played cards, chess or billiards, the violin and piano, walked in the garden, or went on country walks.73 Some patients also pursued their own pastimes. Frederick K., was reportedly 'fond of postage stamps and … glad to get some … he amuses himself at times by pasting old postage stamps into an old Dublin City directory'.74 Thomas K., was 'fond of being out of doors hunting rats or shooting', while James M., amused himself caring for a parrot.75 Recreation was clearly important at St John of God's though. In the early twentieth century, additional arrangements were made including the establishment of a library in 1904 and a handball court a few years later.76 At Hampstead during the 1890s, frequent references were made to recreation in the casebooks, where patients played chess, cards, draughts, billiards, croquet, tennis, walked on the farm, cycled, played handball, had long walks and 'carriage exercise', read novels and newspapers, and watched cricket, tennis and football matches.77 It is important to note, however, that patients were not always willing to engage in recreational activities. For example, John Neilson Eustace wrote that Palms S.M., an army lieutenant, sometimes had 'to be stimulated to walk as far as the garden but the sight of the wheelbarrow to wheel him in is usually enough of a stimulus!'78

Given the more common characterisations of asylum life as ordered, monotonous and isolating,79 the degree of freedom accorded to voluntary and private asylum patients was refreshingly large. In the Staffordshire asylum in England, freedom to go beyond the asylum complex 'was a prerogative of wealth' and patients visited a dairy farm, the theatre, relatives and the seaside.80 In keeping with the practice at the York Retreat,81 in Irish voluntary and private asylums, carriage drives and day trips were organised for those considered suitable to attend. For example, in 1864, Stanley accompanied three of the male patients to the Botanic Gardens and Glasnevin Cemetery in Dublin, where they visited Daniel O'Connell's tomb.82 Voluntary asylum patients were also allowed to walk outside the grounds of the institution, sometimes unattended. In addition, other excursions were organised from the 1860s, including visits to 'popular exhibits, to launches, reviews, &c.'.83 In some cases, patients chose their own entertainment. When Bloomfeld patients William G., and James H., saw an advertisement for the Christy Minstrel's concert at the Rotunda Lying-In Hospital in Dublin, they sought permission from Bloomfeld's superintendent, Mary Pryor, to attend, which they were granted and went in the charge of two attendants. They later told Stanley that 'they were particularly pleased that it was a rich treat and that the singing was performed with good taste and ability'.84

This substantial liberty was also accorded to private asylum patients. In August 1908, a party of thirty, comprised of St John of God's patients and attendants, went for a picnic to the Glen of the Downs, County Wicklow, while patients in that asylum were permitted to go on country drives, walks, excursions and picnics.85 Highfeld patient, Elizabeth B.P., attended two garden parties where she played croquet.86 Fellow patient, Christina McF.S., went to the Gaiety theatre in Dublin 'several times since admission in company with her husband & always conducted herself in a perfectly rational manner' and was allowed home for Christmas.87 At Hampstead, Mosley C.S., an army captain, was granted parole to attend entertainment in town accompanied by an attendant. He visited the Zoological Gardens and the Botanic Gardens in Dublin. These visits refected Mosley's keen interest in botany; he was said to spend 'most of his days walking about observing farm and garden interests' and 'gathered and refned special garden seeds' for John Neilson Eustace.88 Eustace also had a house in the seaside town of Killiney and patients sometimes stayed there in the summer.89

Just as the dangers of patients working in district asylums could bring about further disruption,90 allowing patients to leave the asylum did not always go to plan. Robert P., a Hampstead patient diagnosed with alcoholic insanity, frequently went into town and to the theatre. On these occasions, he was accompanied by an attendant partly on account of his alcoholic tendencies and partly due to his nervousness at venturing far alone. His liberty was eventually reduced when 'it was suspected that patient has been taking some drink on his visits to Dublin'.91 At St John of God's, O'Connell did not always support his patients' liberty. In 1905, he wrote of patient James M.:

In the intervals between his attacks he goes about far too much. I do not understand why he is permitted to go where he pleases and when he pleases … He has taken to motor driving during the past six months and goes out too much for his good. Motor driving is far too exciting for him and to this I attribute the frequent recurrence of his attacks. He should be kept under more restraint – confned more to the grounds.92

In spite of the enhanced sense of liberty among voluntary and private asylum patients, these excursions were not always dignifed or enjoyable. When Maria Jane E.T., was taken along with other Stewarts' patients to a picnic in Howth, she became quite excited, 'kept screaming out "go away", "don't annoy me", when no one was near her, spitting all round her &c'.93 When Joshua S.B., was taken to the park to see a royal visit, he 'wanted to throw stones at King's horses', believing he was ordered to.94 These examples illustrate that, contrary to the positive tone of annual reports for voluntary asylums, which championed patients' excursions, the reality of providing recreational activities for asylum patients was often more challenging.

# Conclusions

Moral therapy remained the dominant ideological framework for treating insanity throughout much of the nineteenth century. Although this framework was initially developed for patients at the York Retreat private asylum, it met with challenges both at York95 and for asylums caring for Irish paying patients. The key issue was to fnd class-appropriate occupations for those who had not engaged in manual work in the outside world. While asylum doctors placed emphasis on employing paying patients, those who had not worked prior to committal were not forced to do so. Nor were patients who refused to work punished, but instead they were encouraged to distract themselves in other ways. In the asylums studied, there is evidence that asylum doctors allowed patients to engage in pursuits they enjoyed, even when these might be considered meaningless. For wealthier patients, amusements provided an alternative means of occupation. Providing patients with suitable distractions therefore overtook institutional economy or self-suffciency as the principal regime for fee-paying patients.

### Notes

### References

#### 206 A. Mauger

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# Respect and Respectability: The Treatment and Expectations of Fee-Paying Patients

In addition to providing class- and gender-appropriate occupations and amusements, proponents of moral therapy preached the benefts of maintaining harmonious surroundings. Yet, rising patient numbers and the consequent need for expanded facilities could greatly disrupt moral therapy.1 While moral therapy was used in Irish district asylums, the late nineteenth century has been characterised as an era of therapeutic pessimism for asylum doctors, due to the ever-rising and accumulating numbers of chronic or 'incurable' patients in the system.2 In modest-sized and large district asylums, fnancial and management problems impacted negatively on patient care.3

As a counterpoint, this chapter considers whether smaller, sometimes underflled voluntary and private asylums were better equipped to provide moral therapy into the late nineteenth century, exploring the treatment and expectations of paying patients in the public, voluntary and private sectors. In her discussion of district asylums, Cox has argued that the language of social class and difference partly constructed the space between patients and staff.4 In the Scottish context, Beveridge has found that social class created tensions between patients and staff and between patients themselves.5 This chapter engages with these fndings, by exploring the extent to which paying patients' expectations of asylum care were informed by their social status and class identity.

As Chap. 2 discussed, district asylum doctors and the lunacy inspectors were apprehensive about mixing paying and pauper patients in district asylums. Despite the Privy Council's decision to restrict paying patients to the same rules, regulations and treatment as the pauper patients, there was clearly an expectation of more class-appropriate care based on their social standing. This included receiving food to which they were accustomed and privacy from the pauper patients with whom they were compelled to reside. Despite concerns to limit jealousies between paying and pauper patients, differences in social class and status resulted in tensions. Many paying patients, anxious to reassert their respectability, expressed unease about their pauper cohabitants' social origins.6 Moreover, the social and political upheaval in Ireland resulted in religious and political divisions between patients. In contrast, the payment of higher maintenance fees at voluntary and private asylums translated into more class-appropriate accommodation and treatment, while the wealthiest patients could expect separate lodgings and special attendants. In these institutions, problems surrounding class, religion and politics were far less common, probably due to the segregation of patients from different social backgrounds.

As this chapter argues, while wealthier patients expected to be treated with 'respect', their carers anticipated certain standards of 'respectable' behaviour in return. This is evidenced in the case notes, where asylum doctors frequently commented on patients' violent behaviour, manners, dress and appearance. These considerations were infuenced by not only the doctrines of moral therapy but also the physician's own understanding of class identity and social status. Notably, although voluntary and private asylums provided care tailored to social class, in line with other asylum populations, social decorum in these institutions was compromised by a surprisingly high level of violence among their more privileged clientele.7

# Expectations of Care

To assess patients' expectations of institutionalisation effectively, it is frst necessary to contextualise their treatment. Studies of the treatment employed in Irish district asylums trace the decline of moral therapy throughout the nineteenth century and the eventual gloom that replaced this ideal towards the century's close. Resulting from the growing involvement of the medical community in district asylums, from the 1830s more 'medical' systems of treatment were adopted.8 Of the asylums studied here, Bloomfeld had the strongest association with moral treatment because it was modelled on the York Retreat. From the outset, the committee which established Bloomfeld 'solicited direct assistance' from the founder of the York Retreat, William Tuke, who was consulted on the construction of an addition to the existing premises and even asked to interview a candidate for superintendent.9 Although physical treatments, including leeching and the administering of emetics, were very much a part of Bloomfeld's early regime of care, moral therapy came to play an increasing role.10 Relatively little is known of the early therapeutic regimes at Hampstead, although it is plausible that the asylum's founders, all medical men, shared similar optimism about the potential of medicine to 'cure' insanity, at least initially. This contrasts with the frst district asylums, which were inspired by the ideology of moral treatment and managed by laymen who fashioned themselves as 'moral governors'.11

By the late nineteenth century, some resident medical superintendents, including Richmond's Lalor (superintendent, 1857–1883) and his successor, Norman (superintendent, 1886–1908), took steps to reinforce the provision of moral treatment. By the 1890s, Norman, who unsuccessfully advocated the 'boarding out' of patients in the community, also increased occupational activity for patients and opened workshops for them.12 As we have seen, the grounds at Richmond were open to patients every day where sports, picnics and entertainments were organised.13 These principles in many ways refected what had long been the norm in voluntary asylums like Bloomfeld and Stewarts, or private asylums such as Hampstead House and Highfeld House. Contrary to the overcrowded and unsanitary conditions in late nineteenth-century Richmond, smaller voluntary and private asylums benefted from lower patient numbers and more spacious arrangements. Obviously aware of this, Bloomfeld's visiting physician, Dr. Valentine Duke, stated in 1862, that the advantages of moral treatment:

can be better experienced in a well conducted asylum of moderate extent, partaking in the domestic arrangements a good deal of a private family, than in some of those very large public establishments which number their patients by hundreds.14

Stewarts, meanwhile, was sometimes underflled and reported space to accommodate more patients. In 1881, the asylum, which could accommodate up to 120 patients, contained only eighty-two.15

During the 1860s, Duke also made numerous recommendations for improved medical treatments, including the erection of a Turkish bath and procurement of seaside lodgings. Duke framed his suggestions with the medical benefts they would bestow, demonstrating a growing emphasis on physical rather than moral treatment.16 In this era, small tensions arose between the asylum's non-medical and medical staff over the most effective forms of treatment. When the visiting surgeon applied leeches to a patient's head, Bloomfeld's house steward, Stanley wrote: 'the leeching made it appears to me, no improvement whatever in him'.17 The following day, when Duke gave 'four powders' to the patient and produced blisters on his temples, Stanley again protested 'but all have proved useless and he appears to be beyond the reach of human skill'.18 Stanley had his own views on what constituted useful therapies for male patients. He was a keen proponent of outdoor exercise and introduced 'football recreation', which he actively participated in almost every afternoon.19 Stanley also frequently remonstrated with elderly patients in a bid to encourage them to go out in the fresh air. Despite any tensions between Stanley and Duke, Bloomfeld's managing committee took Duke's recommendations seriously. Stanley later reported that three of the male patients had taken Turkish baths, that 'they seem to have enjoyed them' and that one patient 'thinks they may likely beneft his health'.20 Meanwhile, lodgings were taken in the summer at the seaside town of Bray for some female patients 'whose state of health indicated the want of such a change'. The committee were impressed by these outcomes, reporting that 'the salutary result has satisfed us of its advantage', and patients continued to be sent to Bray throughout the nineteenth century.21

The blending of moral and physical principles of treatment at Bloomfeld demonstrates the complexities of therapeutic programmes for the insane. Just as individual district asylums were infuenced by the ideologies and character of the physicians who presided over them,22 voluntary and private asylum doctors had the authority to promote a change of regime. Overall, however, ever-rising patient numbers in district asylums such as Richmond frustrated the attempts of even the most innovative asylum physician, who was often powerless to treat anything more than physical illnesses.23

Treatment was also infuenced by the amounts spent on care. In voluntary and private asylums, patients kept at the highest sums could expect larger, even separate, living quarters, higher quality clothing and a special attendant. As such, voluntary and private asylums tailored accommodation to suit patients from wealthy backgrounds. In the 1890s, Stewarts patient, Isabella McE, a ffty-two-year-old widow who had previously been a patient at the Derry district asylum, was initially maintained at £50 per annum. While at Stewarts, she accused the RMS, Rainsford, 'daily of robbing her. Says I get millions sent for her, that hampers of wine and game come for her every morning which matron and I appropriate, that her food is poisoned &c'. She was later 'much pleased' when her maintenance fees were raised and she was transferred to her own separate bedroom.24 In contrast, Beatrice Katherine Q., who accused Rainsford of 'having stolen her money and spent it on women', was removed to an ordinary room after her fees were reduced from £100 to £60 per annum, presumably after a shift in her fnancial circumstances.25 After John Charles B. became a Chancery patient, he was moved to a separate bedroom and dined in the 'better dining room'.26

The same applied at Bloomfeld. In the 1890s, when William R. began to masturbate publicly, he was repeatedly restrained in a straitjacket. Several attempts were made 'to do without his jacket' including the application of 'a lighter jacket with straps round arms' but this did not restrain him from masturbating and a few months later he began 'taking his clothes off on the grounds and exposing his person'. The following year he was still wearing the jacket when in the garden. On another trial without it, he began to throw stones over the garden wall and 'annoyed the neighbours'. A month later, the reporting physician commented:

He has been wearing his jacket while in the garden lately. Unless a man were constantly to stand by him it is not possible to check him suddenly exposing his person, or throwing stones … over the wall and as he only pays a small sum per annum, we cannot give him a special attendant.

This suggests that had William been maintained at a higher sum, he might have been under the care of a special attendant rather than in restraints. William, who had been admitted to Bloomfeld in 1850, was then maintained at £31 per annum. There is no record of his maintenance fee being raised but, by the 1890s, the 'small sum' paid towards his maintenance probably put him at the lower end of the fee scale at Bloomfeld.27

In district asylums, paying patients' experiences were shaped by the Privy Council rules as they were subject to the same treatment as pauper patients. This meant that the amount paid towards patients' maintenance had very little impact on their treatment. Nonetheless, some paying patients and their relatives and friends expected superior treatment, particularly at Richmond. According to one medical offcer, Thomas D., a pensioner patient from the Dublin Metropolitan Police was 'constantly asking for special extras … there is a general tendency to the expression of a sense of superiority'.28 Families and friends could also intervene. When Daniel McK's son, who contributed £26 per annum for his father's maintenance, wrote to the board of governors 'requesting that he may be allowed to wear his own clothes', the board refused, insisting that Daniel should 'wear clothes of institution'.29 A family friend of another paying patient, Daniel N., stressed that the patient was 'respectably connected' and requested 'that he be separated from ordinary lunatics and no expense spared for his beneft'.30

Notwithstanding these expectations, the lunacy inspectors strictly upheld the Privy Council's guidelines. In 1891, the Offce of Lunatic Asylums wrote to Ennis asylum:

Referring to a passage in the Auditors report in which he states that there are three patients in the asylum whose friends contribute in excess of the average cost, and receive for such payment more indulgences as to Food and clothing than other cases – I am directed by the Inspectors to request you will report the facts of these cases to them.31

While the asylum board's response is not documented, a subsequent letter from the Offce drew the board's attention to the Privy Council rules and to the auditor's report that had identifed the problem.32 These letters indicate that the Offce sought to guard against the preferential treatment of paying patients and did not tolerate it.