Belfast District Lunatic Asylum – Moral Treatment, Restraint and Hydrotherapy, 1829 – 1913

By Rebecca Watterson, Ulster University

In 1829, the Belfast District Lunatic Asylum opened following the 1821 Lunacy (Ireland) Act which provided the Lord Lieutenant of Ireland with the ability to establish funded district asylums for the lunatic poor.[1] In January 1826, ‘wanted’ adverts were placed in the Belfast Newsletter by surgeon Robert Mcluney seeking a site on which to build a lunatic asylum for people from counties Down and Antrim, as well as the town of Carrickfergus. It specified the need for at least six acres of land within one mile of Belfast, as well as having access to spring water and running water nearby.[2] A site of farmland owned by a Mr Stevenson was selected and approved by May 1826.[3] The Belfast Asylum opened in June 1829 on the Falls Road, in the west of the City.[4]

Why were People Admitted to the Belfast Asylum?

The Belfast Asylum opened with accommodation for 100 patients in 1829. By 1911 there were 811 patients registered as resident in the asylum according to that year’s census.[5] This increase can possibly be explained by the shift to urban living that occurred during this period as Belfast became increasingly industrialised and people began to work in factories. The population of Belfast increased dramatically. The impacts of poverty, living in overcrowded housing and bad working conditions that came with industrialisation are likely to have increased the numbers of people admitted to the asylum.[6] 

In the 19^th century, every patient admitted to the Belfast asylum was deemed to be insane, with the disease taking one of several forms such as mania (general insanity), monomania (partial insanity), melancholia, or dementia (general incoherency).[7] The causes of insanity were wide ranging including physical causes such as abuse of mercury and other medicines, puerperal affections, head injury and functional disease of the uterus. Other causes point to personal and social issues such as poverty, want of sleep, intemperance, domestic misfortunes, apprehensions relating to a future state and pride.[8]

The Influence of Moral Philanthropy

The Belfast District Lunatic Asylum provided for the insane poor meaning almost all of the patients could not afford to pay for private care. However, we do see discussion on whether to accommodate paying patients. There was uncertainty around whether an expansion should occur to include patients above the rank of pauper who could afford to pay something but not the amount required for the lowest level of board within a private asylum. There were concerns that mixing classes of patient would see problems including higher expectations of the paying patients with regards to diet and surroundings, and these patients receiving more respect from the staff members and being favoured over the pauper patients. This was described as ‘detrimental to the comfort and welfare of the inmates at large’.[9]

In the early years of the asylum, female patients tended to outnumber males, however this shifted in 1840. The asylum management was concerned that there were no further spaces available for male patients and this continued to be a problem.[10] In fact, overcrowding generally became a major issue for the asylum as the nineteenth century progressed. Moving those who were deemed incurable to the workhouse was seen as a possible remedy for this problem. In the 11^th annual report of the Belfast Asylum, it states:

There are many harmless incurables in the house, who, if received into the Workhouses of the district, would tend greatly to relieve the establishment, as well as enhance its usefulness, by being enabled to receive both urgent and ordinary cases, without that delay which, at times, unavoidably occurs…[11]

Image: Replica of a forearm restraint, England, 1850-1920. Science Museum, London. Attribution 4.0 International (CC BY 4.0).

The 1821 Lunacy (Ireland) Act was also concerned with ‘custody of Insane Persons charged with Offences in Ireland’ and so the Belfast Asylum provided accommodation for those persons deemed criminal lunatics.[12]  The 8^th Annual report  of the Belfast Asylum of 1838 contains several references to those admitted to the Asylum following crimes, who were then described as not showing any symptoms of insanity. Three women who committed infanticide are discussed, as well as John Linn, who killed his father with a chisel in 1832. His father was described as ‘a highly respectable individual’. The Lord Lieutenant was asked to reconsider his entry to the asylum on the grounds that he ‘evidenced all the characteristics of a perfectly accountable being’, and so he was sent to the County Jail.[13] There was a deep concern for the ‘moral character’ of the institution and cases such as this were seen as ‘a great evil’ by the management of the Asylum.[14] There was a distinction made between those who entered the asylum as a so-called ‘curative retreat’ versus those who are described as criminal lunatics.[15] 9^th The asylum management and governors considered it inappropriate to provide criminal lunatics with the same accommodation as the pauper lunatics.[16]

Treatments in the Belfast Asylum

In 1837, Samuel Lewis stated that ‘many extraordinary cures have been effected, and upon an average nearly one-half of the patients have been restored to sanity by the skilful and human system of treatment introduced and successfully practised by the governor’.[17] This is certainly a very positive report on the treatment provided in the asylum. In reality, the main ‘treatments’ used in the Belfast Asylum revolved around therapeutic employment, restraint and behaviour management.

Moral Treatment

Work was of significant importance to the management of the asylum who describe it as ‘most beneficial to their [the patients] mental, moral, and physical interests’.[18] Male patients worked weaving linen and cotton, gardening and farming, and women carried out spinning, knitting, and as well as other domestic roles. Work was a key element of moral treatment. There was a prominent belief in the nineteenth century that treating patients as if they were sane would make them more likely to achieve control over their malady.[19] Concerns about ensuring the continued good nature of the asylum can be seen in the 8^th Annual report of the Belfast Asylum which read: ’What can be more cheering to the philanthropist, than to see such numbers of his mentally affected brethren so healthfully engaged, and so comparatively happy, in their allotted pursuits’.[20] There was an air of classism in the judgement of the patients within the asylum related to their ability to work.

Restraint

The Belfast District Lunatic Asylum did use restraint. Several of the annual reports discuss restraint versus surveillance, where the question was posed ‘Is it better to enslave the mind than enchain the body?’. This refers to the use of moral discipline rather than/instead of restraint.[21] This seems strange given the support for moral treatment in the Belfast Asylum, which Scull argues was coercive and controlling in itself.[22] The use of restraint can be shown in the case of a young woman who was married, who expressed a desire to commit suicide, and would beg to have her hands secured so she wouldn’t be able to carry out the act. The asylum managers stated that they obliged ‘as an act of mercy, as well as of paramount duty’.[23] However, this was being discussed at a time when restraint was a matter of significant debate and the non-restraint asylum approach was gaining support. It is quite possible that this version of the story is not representative of truth and the patient was restrained against her will.[24] There are also descriptions of other forms of restraint in the Belfast Asylum including ‘muffs being placed on the hands’ or the ‘imposition of a strait-waistcoat’.[25]

The Belfast asylum management advocated against the total abolition of restraint, believing it to be practically impossible.[26] In 1897, the Lancet discussed the Inspector of Lunatics report by Dr O’Farrell requesting action on the use of restraint as only being used only with the direct instruction of a medical officer, and the keeping of records of every use of restraint and seclusion within the Belfast asylum. Restraint and seclusion were still significant aspects of the operation of the Belfast asylum at the end of the nineteenth century.[27]

Image: Strait jacket, Europe, 1925-1935. Science Museum, London. Attribution 4.0 International (CC BY 4.0)

Corporal Punishment or Hydrotherapy

Hydrotherapy, as it became known in the twentieth century, was popular in many asylums. Water was believed to produce different reactions in the body and mind based on its temperature and these reactions could occur quickly. Hydrotherapy took different forms including baths, wrapping patients in wet cloth, and shower-baths. Shower-baths involved a patient standing or sitting, possibly unable to move their feet, while water was sprayed or poured onto them.[28] In the 11^th Annual report of the Belfast Asylum, the use of the shower-bath on violent patients was described as being useful in subduing them.[29] This would suggest that the patient was quickly taken to the shower amid an outburst of violent behaviour. The question must be asked was this therapeutic or was this punitive? Important perhaps that these shower-baths were also used in prisons during the same period.[30]

Food, Disease and Surveillance

In almost all of the annual reports of the Belfast District Asylum, health was described as generally good and death rates as low. It would seem from these reports that those confined within the asylum were shielded from some of the diseases occurring outside such as cholera, of which only a few cases were recorded, as well as smallpox. However, in 1848, the patients were affected badly by dysentery and 15 of them died[IM1] [RW2] , most probably due to the ongoing Irish Famine.[31]

The patients received 3 meals per day which consisted of stirabout, milk, potatoes, soup, and bread. If you were working as part of your treatment, you also received 4-5 ounces of boiled meat four days in the week. There were exceptions to the diet if it were recommended as part of a patient’s treatment with additions such as mutton, tea, and wine.[32]

In 1848, two night-attendants were introduced to provide medicine and drinks, and to watch over patients who had expressed suicidal ideations.[33] It seems strange that to this stage there would not have been night attendants whilst the patients slept, but nonetheless it does show some interest in the welfare of patients. However, this was possibly an additional method of surveilling patients to control their behaviour.[34]

Image: Shower bath. Joseph Guislain, Traité sur l’Alienation Mentale et sur le Hospices des Aliénés (Amsterdam: Fils & Gartman, 1826), p. 59.

Overcrowding and industrialisation

In 1893, there was provision for sleeping accommodation for 400 patients, but the total number of those confined was 594. The number of lunatics held in the Belfast Workhouse was 492 and the workhouse was being expanded to accommodate increasing numbers of ‘insane lunatics’. There were 112 patients who should have been confined in the Belfast Asylum, living in the Ballymena Workhouse. At this time there was a recognised need for a new asylum however, because this would have significant costs it was decided that a committee should be appointed to devise the best way of providing the necessary asylum accommodation.[35]

In 1893 a special meeting was held which discussed the impact of the industrial growth of Belfast on the numbers requiring asylum care, as we all the impacts of encroaching factories on the air quality around the asylum. It was believed that convalescence in clean air was vital and so a rural setting was recommended for consideration. In 1895, the Belfast Corporation purchased the Purdysburn estate and in 1913 the new Purdysburn Villa Colony was opened, and the Belfast Asylum closed.[36] The building was used as the Belfast War Hospital during the First World War, opening in July 1917. It was closed by the War Office at the end of 1919 and subsequently demolished to make way for the Royal Victoria Hospital.[37]

© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University. Any unauthorised broadcasting, public performance, copying or re-recording will constitute an infringement of copyright.

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[1] Lunacy (Ireland) Act, 1821; Mark Finnane, Insanity and the Insane in Post-Famine Ireland (London: Croom Helm, 1981) pp. 25-27; Joseph Robins, Fools and Mad: A History of the Insane in Ireland (Dublin: Institute of Public Administration, 1986), p. 66.

[2] ‘Lunatic Asylum for the Belfast District’, Belfast Newsletter (3 January 1826).

[3] ‘Belfast Lunatic Asylum’, Belfast Newsletter (26 May 1826).

[4] ‘Belfast District Lunatic Asylum’, Belfast Newsletter (26 May 1829).

[5] ‘1926 Census Belfast County Borough Report’, p. xxvii.

[6] David Wright, ‘Getting Out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century’, Social History of Medicine,10 (1997).

[7] Fifteenth Annual Report of the Belfast District Asylum for the Insane Poor (Belfast: Francis D. Finlay, 1845), p. 8.

[8] Tenth Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1840), p. 4; Sixteenth Annual Report of the Belfast District Asylum for the Insane Poor (Belfast: Francis D. Finlay, 1846), p. 10. See generally Damien Brennan, Irish Insanity; 1800-2000 (London: Routledge, 2014).

[9] Seventeenth Annual Report of the Belfast District Asylum for the Insane Poor (1847). See also Alice Mauger, The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care (Basingstoke: Palgrave Macmillan, 2018).

[10] Tenth Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1840), p. 6.

[11] Eleventh Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1841), p. 10. See also Markus Reuber, ‘The Architecture of Psychological Management: The Irish Asylums (1801-1922)’, Psychological Medicine, 26 (1996) p. 1179.

[12] Lunacy (Ireland) Act (1821).

[13] Eighth Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1838), pp. 6-8.

[14] Ninth Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1839), p. 4; Eighth annual report of Belfast District Asylum, p. 6.

[15] Ninth Annual Report of Belfast District Asylum, p. 4.

[16] Pauline M. Prior, ‘Prisoner or Patient? The Official Debate on the Criminal Lunatic in Nineteenth-Century Ireland’ History of Psychiatry, 15 (June 2004).

[17] Samuel Lewis, A Topographical Dictionary of Ireland (London: S. Lewis and Co., 1837), p. 192.

[18] Eighth Annual Report of Belfast District Asylum, p. 13.

[19] Mauger, The Cost of Insanity in Nineteenth-Century Ireland, pp. 190-196.

[20] Eighth Annual Report of Belfast District Asylum, p. 10.

[21] Tenth Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1840), p. 9.

[22] David Ingleby, ‘Mental Health and Social Order’, in Stanley Cohen & Andrew Scull (eds), Social Control and the State, Historical and Comparative Essays (New York, NY: St. Martin’s Press, 1983).

[23] Tenth Annual Report of Belfast District Asylum, p. 10.

[24] John Connolly, The Treatment of the Insane Without Mechanical Restraints (London: Smith, Elder & Co., 1856); Leslie Topp, ‘Single Rooms, Seclusion and the Non-Restraint Movement in British Asylums, 1838–1844’, Social History of Medicine, 31 (2018).

[25] Eleventh Annual Report of the Belfast District Asylum for the Lunatic Poor (Belfast: Francis D. Finlay, 1841), p.12.

[26] Tenth Annual Report of the Belfast District Asylum, pp. 8-11.

[27] ‘Ireland’,  Lancet, 149 (1897).

[28] Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York, NY: John Wiley, 1997), pp. 120-121; ‘Shower-Baths in Lunatic Asylums’,  Lancet, 35 (1841).

[29] Eleventh Annual Report of Belfast District Asylum, pp. 12-13.

[30] Stephanie C. Cox, Clare Hocking, and Deborah Payne, ‘Showers: From A Violent Treatment To An Agent Of Cleansing’, History Of Psychiatry, 30 (2018).

[31] Eighteenth Annual Report of the Belfast District Asylum for the Insane Poor (Belfast: Francis D. Finlay, 1848), pp. 16-17. For more on the impact of the Famine in Belfast, see Christine Kinealy and Gerard Mac Atasney, The Hidden Famine: Hunger, Poverty and Sectarianism in Belfast, 1840-50 (Pluto: London, 2000).

[32] Eleventh Annual Report of Belfast District Asylum, p. 26.

[33] Eighteenth Annual Report of Belfast District Asylum, p. 20.

[34] David Ingleby, ‘Mental Health and Social Order’, in Cohen and Scull (eds), Social Control and the State.

[35] ‘Lunatics in Belfast Asylum’, House of Commons Debates (1 September 1893), vol. 16 cc1701-3.

[36] Gillian Allmond, Levelling Up the Lower Deeps: Rural and Suburban Spaces at an Edwardian Asylum in Georgina Laragy, Olwen Purdue and Jonathan Jeffrey Wright (eds), Urban Spaces in Nineteenth-Century Ireland (Liverpool: Liverpool University Press, 2018), pp. 131-135.

[37] W. R. Dawson, ‘The Work Of The Belfast War Hospital (1917–1919)’, Journal Of Mental Science, 71 (1925).

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