«»This is an extended version of a paper presented at the Conference Schizophrenia 1908-2008 : « Psychosis and Psychoanalysis » in St. Vincent’s Hospital, Dublin, on 6 December 2008.
1908 was an important year in the history of psychoanalysis. The first psychoanalytic Congress was held in Salzburg in the spring of that year and Freud tells us that it “brought together friends of psychoanalysis from Vienna, Zürich and other places”.[1] One of the results of this Congress was the founding of a periodical called “The Yearbook for Psychoanalytic and Psychopathological Research” which appeared for five years under the editorship of Jung and the direction of Freud and Bleuler.
This publication gave expression to an intimate cooperation between Vienna and Zürich. Freud continues:
“Bleuler’s great work on Schizophrenia in which the psychoanalytic point of view was placed on an equal footing with the clinical systematic one, completed this success – after this it was impossible for psychiatrists to ignore psychoanalysis any longer”.[2]
Bleuler did not agree with Freud as to the aetiology of Schizophrenia because he rejected the Freudian concept of libido, preferring the term “affectivity” in general. Whereas Freud understands Schizophrenia in terms of a libidinal cathexis and a return to autoeroticism, Bleuler wonders if every unpleasant affect can’t bring about repression without this having to involve sexuality. Bleuler therefore prefers the term “autism” to “autoeroticism”. He leaves out the Eros. This “psychiatrist of high repute” (Freud’s term) was born in a little village called Zollikon just outside Zürich’s city walls in 1857 – a year after Freud and Kraepelin. His forefathers and parents worked on the land. Bleuler grew up in an ambitious and progressive family, something which would later be reflected in his own scientific ambition. When the new Burghölzli clinic opened in 1870, not far from Zollikon, its first directors were academics. They were mostly German who spoke only High German and therefore couldn’t understand patients speaking their own dialect. As Bleuler’s son, Manfred, has written: “Hence the hope grew in the local people that their own sons might undertake further studies and become better doctors. It was in this context, as the first in the Zollikon area to study medicine, that Eugen Bleuler decided to become the kind of doctor his own people wanted”. [3]
We are led to ask – what kind of doctor do our own people want, and a further question – what have we left out?
That this “what do you want?” is punctuated by a demand which is always dependent on an Other’s whim, is clearly discernible from even a cursory look at our history, whether that be personal or social. In turn, “the unconscious is that part of my history that is marked by a blank or occupied by a lie – it is the censored chapter” as Lacan reminds us.[4] But the truth can be refound because most often it is written elsewhere. Lacan further reminds us that we can find it “inter alia, in traditions and even in the legends, which in a heroicised form bear my history”.[5]
Despite the myriad Irish legends myths and traditions, the dark underbelly of mental illness still remains hidden. To locate the pain of these imperceptible murmurings is an almost impossible task which would necessitate anchoring all these insane words and images in time.
Dr. Joseph Robins, in his important book, Fools and Mad. A History of the Insane in Ireland,[6] does just that. Written in 1986, this work is an attempt to describe a chain of discourse around the dust of this pain and it leaves us in no doubt that this is part of the Real of our heritage.
I have divided Robins’ history into four principal eras or stages. Freud has written on the defensive measures a subject adopts when he wishes to refuse what he calls “intolerable reality” – Freud calls this a “Splitting of the Ego in the Process of Defence”.[7] Therefore, following Freud, the first stage can be called “the time of the trauma”. The second stage will be called “the time of fright and guilt”. The third stage may be called “the time of compromise” and the fourth and final stage is called “the time of paying the price”. These are broad categories and serve only as a first approach to the question. The passage from one stage to another is not a progression from obscure or inhuman conceptions to a final understanding of the truth about madness. Rather, each stage tries to explain the differing defensive measures introduced over time to deal with this Real.
Stage I: The Time of the Trauma
That the Symbolic is preeminent in the work of Freud is evident throughout his writings and is clearly delineated in “An Outline of Psychoanalysis”.[8] There, Freud accentuates once more that “reality will always remain unknowable” but our primary sense perceptions will help us to make connections with the external world, and these in turn can be “reliably reproduced or reflected in the internal world of our thought, and a knowledge of this will enable us to understand something in the external world, to foresee it and possibly to alter it”.[9] During this first stage, the “Time of the Trauma”, the Imaginary coordinates of this Symbolic seemed to hold sway. In early times the origin of all madness was believed to be due to the malignant influence of some deity. Illness was the penalty paid for wrong doing – for offending a deity. The cure like the cause could usually be found in further supernatural intervention when the wrath of the Gods had been appeased.
In pre-Christian Ireland, one of the most dreaded powers attributed to the highly respected and greatly feared druidic priests was that of causing madness. A druid prepared a madman’s wisp – a ball of straw or grass – this was believed to cause madness by throwing it in the victim’s face. Belief in this prevailed until at least early in the fifth century A.D. when the Senchus Mór containing the codified laws of ancient Ireland was compiled. In other words, until a uniquely Irish Symbolic came to be written.
Early Irish legal manuscripts reveal an interesting and important link to Christianity. For example, the name for a fool was a drúth – he appears to have been invested with divine protection because he is described as a córath dé, which translates as “with the grace of God”. This is probably the origin of the modern Irish duine le Dia – a person with God to signify a special needs person. In some of the earliest Gaelic poems and legends the word geilt or gealt is used both as a noun and an adjective to describe a madman and geltacht to describe the state of madness. The Brehon laws, which flourished during the seventh and eighth centuries, provided considerable legal protection for the insane. For example, if a madman and a madwoman had been encouraged to have sexual intercourse by persons making fun of them, the persons concerned were obliged to foster any consequent offspring and were also responsible for the crimes of such offspring.
There are few more fascinating features in the mythology and folklore of the insane in Ireland than the belief which grew up over a period of centuries about Gleann na nGealt, the Glen of the Mad, in County Kerry.
There was a belief in the strange healing powers of the Glen as early as the twelfth century. This belief broadened and strengthened over the years. As late as 1841, Sean Ó Donnabhán writes:
“It is still believed by the natives that all madmen have a yearning to make to this valley and that their gloomy desire is relieved by drinking of the clear waters and eating of the watercress of Tobar na nGealt (The Well of the Mad) which is situated in the South East corner of Dun An Óir South”.[10]
It wasn’t until the development of a system of district lunatic asylums during the nineteenth century that popular belief in the mysterious curative qualities of the Glen gradually faded.
To those whose sensibilities may be touched by the term “lunatic”, it wasn’t until 1908 – that year again! – that the ending of the words “lunatic” and “asylum” were recommended. While the word “patient” quickly replaced “lunatic”, the inspectors of lunacy continued to operate from the office of lunatic asylums and to report on district lunatic asylums, until the ending of British administration in Ireland. The word “lunatic” is still used in Irish law to refer to any person found by inquisition, idiot, lunatic or of unsound mind and incapable of managing himself or his affairs. The Lunatic Regulation Act of 1871 – Section II is still in force here. The Other as foreigner still reigns in the very heart of us. As James Joyce has written:
“I cannot write or speak these words without unrest of spirit. His language so familiar and so foreign, will always be for me an acquired speech. My soul frets in the shadow of his language”.[11]
Our soul has been fretting for a long time!
It is also interesting to note that Dublin fell to the Normans in 1170, but the Norman Conquest of Ireland was never undertaken in a systematic fashion. F. X. Martin comments thus:
“As a general rule the Normans contented themselves with the plains, the coasts and the riverways: they left the hill-country, the woods and the boglands to the native Irish”.[12]
Therefore we have a place – a particularly Irish place – the Glen of the Mad where people could be cured, but they had to go there. This gesture of exile – of banishment to a carefully circumscribed place – was heavily loaded with meaning. This theme of exile, of movement which ran throughout European thought from the Middle Ages up to the end of the sixteenth century has an Irish focus that is particular. As Michel Foucault puts it in his monumental History of Madness “the concern with cure and exclusion fused within the sacred space of the miraculous”.[13] Gleann na nGealt therefore became a place of exclusion – a holy land where madness awaited its deliverance so that the madman became a prisoner of that passage. Here, in Gleann na nGealt, the real of madness and the real of geography coincide. The madman, traumatised by the passage to Gleann na nGealt becomes a mirror of the trauma inflicted by the foreigner on his passage though the country, so that the madness invoked by the Other, provokes the foreignness of that Other. Freud tells us that:
“Such an event as an external trauma is bound to provoke a disturbance on a large scale in the functioning of the organism’s energy and set in motion every possible defensive measure”.[14]
Stage II: The Time of Fright and Guilt
This second stage, which is called the “Time of Fright and Guilt”, is characterised by Freud as the time for (the ego) “to decide either to recognise the real danger, give way to it, and renounce the instinctual satisfaction or to disfavour reality and make itself believe that there is no reason to fear”.[15]
This defensive strategy was imperative in seventeenth and eighteenth century Ireland as there was everything to fear. Joseph Robins tells us that it can hardly be said that the onset of the Enlightenment brought with it a more understanding attitude to the insane. One singular event happened during the first half of the seventeenth century in Ireland. The land of Ireland changed hands. By the end of the seventeenth century the violence of the English armies, the systematic confiscation and settlement of Irish land, and the application of harsh laws aimed at extirpating Irish Catholicism had not only established absolute English control, but had virtually destroyed the whole framework of Gaelic civilization. From now on, according to Robins, “public measures rare enough though they might be in regard to such matters as provision for the insane would be English in origin and Protestant in inspiration”.[16] This Protestant ethic placed great emphasis on an ordered society and on the obligation of the individual to behave and conform. Insanity fell into the second category as abandoned homes, abandoned dreams, and the sheer hardship of poverty itself took shape. The houses of correction which developed together with the jails were the repositories of those who were insane, who were a social nuisance or simply those who were a threat to good order.
An analysis of this stage of Irish society shows that the Real of suffering has taken hold like wildfire. There is no place to hide. Poverty and fear stalk the land. Can we not say that at this juncture something has gone so awry in the Symbolic that the Real has become co-extensive with it and the Imaginary is eclipsed?
But slowly a new sensitivity to poverty and the duty to relieve it came into being. A European-wide social sensibility must have almost imperceptibly taken shape, probably over many years, until suddenly it became manifest in the second half of the seventeenth century. To alleviate guilt and attenuate fear the seventeenth century began to create vast houses of confinement all over Europe. Since then madness has been linked to this place of confinement and as Foucault puts it: “to the gesture that designated it as its natural place”.[17] Foucault adds: “Before it developed the medical meaning that we associate with it….confinement was demanded for reasons quite independent of any desire to cure”.[18] The houses of confinement became the moral punishment of poverty.
Dean Swift, the founder of St. Patrick’s Hospital which was granted the Royal Charter in 1746, typifies this moral authority. He announced his intention of providing in his will the establishment of a lunatic asylum in the following verse:
He gave the little wealth he had
To build a house for fools and mad
And showed by one satyric touch
No nation wanted it so much.[19]
In 1810, a grant was given to establish a separate asylum for the reception of lunatics from “all parts of the Kingdom”, as it was so sweetly put. This new asylum, which was opened in 1815, was called the Richmond Asylum after the Lord Lieutenant – The Earl of Richmond.
It wasn’t until 1958 that its name was changed to St. Brendan’s Hospital. It is interesting to note that the guiding principle which led to more reform during the latter half of the 18th century, was ethical, not medical. This was because Reason was the dominant defensive strategy and anything which did not coincide with this age of Reason was excluded. The closing in and silencing of the mad became a mirror of the “mad” Irish. How to distinguish one from the other?! This mirroring underwent a further irony when in 1790 Phillippe Pinel of the Bicêtre Asylum in Paris and William Tuke a Quaker tea merchant from York liberated patients from their chains. The United Irishmen, founded in 1791, sent a delegation to London to ask for the abolition of the Penal Laws. The result was the 1793 Relief Act which gave Catholics the vote. But Catholics were still excluded from Parliament, from the judiciary and from the higher offices of the State. So limited Catholic emancipation coincided with the seeming liberation of the insane. The Act of Union was passed in 1800. Ireland was now subject to the Parliament at Westminster – but there was still the “land” question.
Stage III: The Time of Compromise
Freud is clear how this stage comes about. It is, as he says, a “very ingenious” solution to the difficulty of taking on board the fear inculcated by the reality of the situation.” Freud continues:
(The subject) “replies to this conflict with two contrary reactions both of which are valid and effective. On the one hand, with the help of certain mechanisms he rejects reality and refuses to accept any prohibition; on the other hand, in the same breath, he recognises the danger of reality, takes over the fear of that danger as a pathological symptom and tries subsequently to divest himself of the fear”.[20]
Something new broke forth in the Real which necessitated a further Symbolic shift with all the Imaginary repercussions of this. This something “new” was 1845 – the year of the beginning of the Great Famine.
This was the time which Robins calls “the medical takeover”.[21] It happened in Ireland in the dark year of 1845 and for political and social reasons it would be more appropriate to call it the handover to the medical profession. In 1845 the population was eight and a half million. By the end of the famine in 1848 something like a million people had succeeded in getting away and another million had perished. During the height of the famine in 1846, Father Matthew – of temperance fame – wrote:
Vegetation. The wretched people were wringing their hands and wailing bitterly at being left foodless”.[22]
This is not an imaginarised Real, nor a Real that is capable of being Symbolised – this is the Real, full stop. All that the country had available at the time was the local workhouse or District Lunatic Asylum, which despite a spartan and oppressive atmosphere quickly became a haven for the huge range of human misery. How many made their way to these places is mere conjecture but it is no accident that 1845 was the year of this handover. Colm Tóibín writes:
“It is plain from much writing about the Famine that two things happened in its aftermath. One, people blamed the English and the Ascendancy. Two, there began a great silence about class division in Catholic Ireland. It became increasingly important as nationalist fervour grew in the years after the Famine, that Catholic Ireland, or simply Ireland was presented as a nation one and indivisible”.[23]
In other words, the Other had become the enemy, and secondly, the land itself had “produced” this non-compromising Real. Had the “land” then not become the Other par excellence?
Michel Foucault reminds us that:
“It is important to remember that….for the place madness was to occupy in modern culture that homo medicus had not been called to arbitrate between sickness and evil – but rather as a guardian to protect others from the confused danger that emanated from inside the walls of confinement”.[24]
Foucault adds:
“If today doctors now reign in such places, it is not through any right of conquest resulting from the vital force of their philanthropy or their concern with scientific objectivity. It is because confinement itself slowly took on a therapeutic value”.[25]
An analysis of this time shows that in this highly ingenious social compromise two contrary reactions were harmonised – that of protection against the madness that the insane represented and the curing of sickness.
Because of the special circumstances under which the medical handover was realized in Ireland – have we not then imposed on our psychiatrists some of the burden of our history? If we take language seriously and if we believe that the word is capable of being transmitted have we not then demanded from the doctors “our own people want” a desire that they be involved in a certain kind of destiny?
Stage IV: The Time of Paying the Price
Freud tells us that “the psychical apparatus is intolerant of unpleasure: it has to fend it off at all costs and if the perception of reality entails unpleasure, that perception – that is, the truth – must be sacrificed”.[26]
The question may be asked: What part of Truth have we sacrificed? What have we left out? Part of the price we have paid for this defensive position which we had adopted over the years and which increases as time goes by is the forgetting of our history – or is it more appropriate to call this a refusal of our history? As Séan Ó Faoláin puts it, when the Irish surrendered their lands they “surrendered some portion of their minds, their memories, their traditional outlook”.[27] What we have surrendered in the Real, we refuse in the Symbolic, and therefore allow ourselves indulge excessively in the Imaginary. Freud calls this “a rift in the ego which never heals but increases as time goes on”.[28]
Instead of refusing an excess of pleasure, we seem to have sacrificed the Truth on the altar of narcissistic privilege and, as a result, the truth of the singularity of the human subject has been quietened. As Dr. Greene, the kindly psychiatrist in Sebastian Barry’s great novel The Secret Scripture, puts it:
“The fact is that we are missing so many threads in our story that the tapestry of Irish life cannot but fall apart. There is nothing to hold it together. Roseanne (his patient) is just a bit of paper blowing on the edge of the wasteland”.[29]
In an article in “The Letter”,[30] Dr. Mary Darby comments on a related issue. Dr. Darby writes:
“We are in a din of demands, from our patients, their families, the police, the courts, our medical colleagues” and continues “the psychiatric patient has become the object of neurochemical and neuroanatomical research”.[31]
The dilemma of the contemporary psychiatrist, caught between these incessant demands and the seductions of the drug companies, makes it difficult for him or her to hear the language of subjectivity. The hypothesis of unconscious knowledge has been refused and the truth of the fact that we are not the centre of our world but are rather subjects determined by that unconscious is also refused. Lacan gives us an insight into the mechanism of this refusal. He states:
“The psychiatrist interposes between himself and the madman, a certain number of protective measures … it is enough to have a little idea, an organo-dynamism for example … an idea which separates you from this kind of being who is before you, who is the madman”.[32]
“Every nation has a history – the Jews and the Irish have a psychosis”, Brendan Behan once said. As we smile wryly, perhaps he is nearer to the truth than we would like to admit – perhaps he is indicating a Real that we do not accept, that we refuse?
We may classify the different stages of an Irish history of mental illness in the following way. The “Time of Trauma” could be classified as a real geography. The “Time of Fright and Guilt” could be said to be a mental geography. The “Time of Compromise” could be said to belong to a compromised geography. The “Time of Paying the Price” could be said to belong to a chemical geography which is a form of globalisation of mental health.
The history of psychiatry in Ireland has yet to be written. That history will undoubtedly contain the names of those silent psychiatrists who worked heroically at what they were called to do. These include Dr. Joseph Lalor, the first medical superintendant of the Richmond Hospital (1857-1886) who was a dedicated and enlightened doctor, and Dr. Connolly Norman, who succeeded him – the most progressive Irish asylum doctor of that period (1886-1908) – as well as Dr. M. O’C. Drury of St. Patrick’s Hospital (1947-1976), a student of Wittgenstein, who wrote a salutary book called The Danger of Words.[33] There will of course be others, including Dr. Noel Walsh, Dr. Mary Darby, who co-founded the School of Psychotherapy at the hospital in which we meet today along with Dr. Cormac Gallagher. And last but not least there will be those who have supported the psychoanalytic endeavour since Cormac Gallagher first brought the “plague” of Lacanian psychoanalysis to these shores in 1974.
When that history comes to be written, perhaps some psychoanalysts will co-sign it!
Address for Correspondence:
Helen Sheehan
6 Annsbrook
Clonskeagh
Dublin 14
[1] S. Freud, On the History of the Psychoanalytic Movement, SE XIV (1914), p. 26.
[2] Ibid. p. 28.
[3] M. Bleuler, “Zur Entstehung und Bedeuting von Eugen Bleuler’s Werk” in E. Bleuler, Dementia praecox oder Gruppe der Schizophrenien (Nijmegen: Arts & Boeve, 2001) p. xi; Ellenberger, The Discovery of the Unconscious (New York: Basic, 1970), p. 286 [cited in T.G., Dalzell,. Freud’s Schreber between Psychiatry and Psychoanalysis. On Subjective Disposition to Psychosis. Karnac, London 2011, pp. 244-245].
[4] J. Lacan, The Function and Field of Speech and Language in Psychoanalysis in Ecrits. A Selection. Trans. B. Fink (New York and London: Norton & Company, 2002), p. 50.
[5] Ibid.
[6] J. Robins, Fools and Mad. A History of the Insane in Ireland, Dublin: Institute of Public Administration, 1986.
[7] S. Freud, “Splitting of the Ego in the Process of Defence”, SE XXIII (1940), pp. 271-275.
[8] S. Freud, “An Outline of Psychoanalysis”, SE XXIII (1940), pp. 141-207
[9] Ibid., p. 196
[10] S. Ó Donnabhán, “Béaloideas: The Journal of the Folklore of Ireland Society” (1962), p. 147.
[11] J. Joyce, A Portrait of the Artist as a Young Man (London: Paladin Books), p. 86.
[12] F. X. Martin, The Normans: Arrival and Settlement in the Course of Irish History. Ed. T. W. Moody & F. X. Martin (Dublin: Mercier Press, 1967), p. 104.
[13] M. Foucault, History of Madness. Trans. J. Murphy & J. Khalfa (London and New York: Routledge, 2006), p. 10.
[14] S. Freud, Beyond the Pleasure Principle, SE XVIII (1920), p. 29.
[15] S. Freud, “An Outline of Psychoanalysis”, SE XXIII (1940), p. 275
[16] J. Robins, op. cit., p. 23.
[17] M. Foucault, op. cit., p. 47.
[18] Ibid., p. 62.
[19] J. Swift, Poetical Works. Ed. H. Davis. (London: Oxford University Press, 1967), p. 42.
[20] S. Freud, An Outline of Psychoanalysis, SE XXIII (1940), p. 275.
[21] J. Robins, op. cit., p. 92.
[22] D. Kerr, A Nation of Beggars. Priests, People and Politics in Ireland, 1846-1857
(Oxford: Clarendon Press, 1994), p. 33.
[23] C. Tóibín. The Irish Famine (London: Profile Books, 1999), pp. 16-17.
[24] M. Foucault, op. cit., p. 358.
[25] M. Foucault, op. cit., p. 437.
[26] S. Freud, An Outline of Psychoanalysis, SE XXIII (1940), p. 237.
[27] S. Ó Faoláin, The Irish (London: Penguin, 1969), p. 66.
[28] S. Freud, op. cit., p. 276.
[29] S. Barry, The Secret Scripture (London Faber and Faber, 2008), p. 183.
[30] M. Darby, “The Envers of Psychiatry. Psychoanalysis and Psychiatry should be Friends”, The Letter. Lacanian Perspectives on Psychoanalysis 24 (2002) pp. 26-27.
[31] Ibid.
[32] J. Lacan, Petit discours de Jacques Lacan aux psychiatres, Nov. 1967; Psychoanalysis and the Formation of the Psychiatrist. Trans. C. Gallagher, Nov. 1999. Unedited. p. 6.
[33] M. O’C. Drury, The Danger of Words, London: Routledge & Kegan Paul, 1973