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Remembering St Mary’s

Mental illness is no laughing matter

It’s two years since St Mary’s Hospital, Castlebar, closed its doors, but how have attitudes to mental illness changed since it first opened in 1866?

Áine Ryan

MENTAL HEALTH, madness, insanity, dementia, craziness, lunacy – there are so many terms for such an elusive subject, condition, state of mind. But what do all these words really mean? Surely, the majority of people suffer fleeting moments of losing grip, of not being in full control. Like in Pink Floyd’s signature song ‘Brain Damage’ – the lunatic has undoubtedly been in all our halls, on all our lawns. 
On the respectable, socially-acceptable end of the spectrum, mental health covers eccentricity and oddness. We all know somebody to whom we have attributed that mantle: the oddball neighbour who refuses to answer the doorbell; the wacky teenager who dyed his hair purple and plays thumping rap music until dawn; the depressed-looking mother in the schoolyard; the manic executive who spends 18 hours a day in the office.
At the other extreme, there is the ‘weirdo’ who talks incessantly to himself, the recidivist self-harmer who digs the blade deeper each time, the former soldier whose nightmares won’t go away, the grandmother with Alzheimer’s, the special needs teenager who had birth complications.  
The list is endless. The cures are countless.
Over the centuries society has always devised methods of exercising control over so-called ‘deviant’ behaviour. The norm, the average, the status quo is what an ideal society aspires to – but never achieves. The walls may have been knocked from around our institutions during a decade of enlightenment but new – albeit symbolic – ramparts are continually built.
A fortnight ago the Irish Catholic bishops called on the Government to pull back from plans to relocate the Central Mental Hospital to the site of a new major prison complex in north County Dublin. After a conference, the group observed that this plan ‘would increase the stigma associated with mental illness and impede the rehabilitation of patients’.
The radical and leading international commentator on mental health, Michel Foucault, explains the concept of insanity simply. He defines it as ‘a social construct which is the product of the fact that people do not like and are scared of what is unknown or different’. So, over the years, these people have been ‘banished’ in various ways, he argues.
“When it comes to mental illness, we put these people in institutions far away from our sight and we forget them instead of trying to understand,” he wrote in the 1960s. Foucault uses the dramatic example of the Salem witch-hunts – made famous by the Arthur Miller novel and Daniel Day-Lewis film, The Crucible – as a case in point. They took place in 1692, in New England when 150 people were tortured and put in jail and 20 people were hanged for allegedly becoming involved in voodooism.
Fortunately, such barbaric days are long gone and the mental health services in the developed world have effectively been revolutionised during the last 50 years.
In recent decades the focus has significantly increased to a network of community mental health services which encompass day centres, day hospitals, community residences, vocational training and supported work here in County Mayo. Self-support groups have also become very much part of the new-style services. They now make up a well-structured and dynamic element of the overall dynamic of this innovative and forward-thinking programme. There is also a strong partnership with such voluntary organisations as the Mayo Mental Health Association, Aware, Grow, Phrenz, SAI and the Irish Association of Suicidology.
These organisations have grown deep and sensitive tentacles in both our urban and rural communities; it is to their huge credit that they depend for much of their work on the strong spirit of volunteerism that still pervades in Mayo. Unfortunately, it does not mean that, in a fast-changing society, new causes of mental instability and stress don’t continually manifest themselves and challenge this caring profession.
The Pink Floyd lyrics still have relevance: “The lunatic is in my head/ The lunatic is in my head/ You raise the blade, you make the change/ You re-arrange me ‘til I’m sane/ You lock the door and throw away the key.”

History of the hospital

ORIGINALLY known as the District Lunatic Asylum, when St Mary’s Hospital, Castlebar opened its historic doors on St George’s Day, 1866, it catered for 132 patients.
They had been transferred from Ballinasloe by horse-drawn carriages, where, up until then, all of Connacht’s mentally ill patients had been catered for in St Bridget’s Hospital, around 70 miles from the Mayo capital.
The original St Mary’s was about a quarter of the size of the present complex and, within a decade of its opening, the Board of Governors complained that the hospital was ‘over-crowded’ and catering for 100 more patients than for which it was designed. Subsequently, extensions were built in 1878, 1882, 1902 and 1936, with the foundation stone of the new wing bearing the inscription: ‘Farsinge a Leigeadh le Teach na nGealt, 1934’.
During early Christian and medieval times, it was the Catholic Church religious orders who largely looked after those ‘troubled by insanity’.
Madness was variously viewed as either a transmittable illness or the possession of those inflicted individuals (witches, for example) by dark forces (the devil).
In 1757, the famous Dean, Jonathan Swift, established St Patrick’s Hospital in Dublin, thus initiating a formal institutional system to address the social problem of mental illness.
Clearly, this ethos engendered an atmosphere of incarceration and separateness from society at large. St Mary’s – like St Patrick’s – was surrounded by a high outer wall and by locked gates, locked doors and locked rooms.
By 1957 a slow transformation of this regimented ethos began. The locked main gates were removed and, in 1963, during the late Noel Browne’s tenure as Minister for Health, the high outer wall was knocked.
Nine years later St Theresa’s Admission Unit was opened in 1972 and a hostel for former residents was also opened at Rock House two years later.
On May 9, 1981, Padraig Flynn – then a Minister for State at the Department of Transport and Power – officially opened the new Industrial Therapy Unit. 
With the new emphasis on community care, group homes for former patients were established around the town by the Mayo Mental Health Association. At its height, in the 1950s, there had been 1,300 residents living at St Mary’s Hospital. It was effectively a self-sufficient community within a community – with its own bakery, butcher’s and vast vegetable gardens on the Breaffy Road. 
After almost 140 years of service, it closed in 2006 as a result of the new Government policy, ‘A Vision for Change’, with the iconic buildings now mainly used by the GMIT (Galway-Mayo Institute of Technology).

‘Some families didn’t want to know, because there was a stigma attached to mental health problems’

Carmel Mulchrone

I STARTED my training as a psychiatric nurse in St Mary’s in 1975. Little did I think I’d still be attached to the service in Castlebar 33 years later. I’m from Cloonfad, in Roscommon, and had actually applied to Castlerea hospital but back then they didn’t usually appoint you to your home area.
In the beginning I was afraid, there were patients everywhere, so for the first months I shadowed more experienced nurses everywhere. Back then there was still about 1,000 patients and about 30 to 40 in every ward. They had no privacy.
Female nurses looked after female patients and male nurses looked after male patients. You could not cross the divide or you were reprimanded.
The men and women also dined at separate times in the big refectory.
You couldn’t imagine how disillusioning it was to see patients that were there for 20, 30 years. Some of them had no family. Then, as I settled in, I got to know them well. We were all like a big, extended family. We knew a lot about each other; we knew all their history. Sometimes there would be three or four members from one family.
Some of them were depressed, or had schizophrenia. If only you could have moved the clock forward, they could have been treated in the community or at home, like nowadays. But the whole regime was based on the Mental Treatment Act 1945.
Some of the patients were ‘voluntary’ and could leave once they gave 72 hours’ notice. Others were called ‘temporary’ (but it meant ‘involuntary’, they were signed-in).  The system dictated that they could be detained for six months and then the case was reviewed by the consultant and then they could be detained for another six months.
 Some were left there for years, with nobody to sign them out. Some families didn’t want to know, because there was a stigma attached to mental health problems. There were no day centres, no day hostels.
There were young women, who had babies outside marriage, put in to hide them away from society. There was a mother and son there for years but neither of them ever knew they were related. The staff never knew either.
It was only when a nurse did some research for a woman trying to trace her mother that the connection was discovered. Both the mother and son were dead by then. He was a really nice fellow. He’d always be watching for the ‘rounds’ and warn us: “The matron is coming. The matron is coming.”
Times were so different. It was terrible.
But you also had great laughs as well. Some of the old ward sisters would petrify you but even on the hardest day, you had a laugh. But there were no facilities, not like today. If a patient was incontinent, there were no pads, no creams. You had soap and water and your hands.
The nurses did all the cleaning, scrubbing, moving furniture. You’d have to lift everything so you wouldn’t scrape the floor. Everything had to be in perfect, straight lines.
It was terrible that some of these people were locked in there for years, like in a jail. The high walls were knocked before I started working there. They were built so that they wouldn’t be seen, as well as for security. Some of them were really forgotten about.
The hospital had its own laundry, its own milk, vegetables, breads. It was almost self-sufficient.
The patients worked along with the staff and they also worked in the Therapy Unit making rugs, chairs, scarves and socks. Those patients got a little allowance.
You know, the line between high intelligence and mental illness is so thin. You used to see one generation after another of a family coming in. It’s absolutely fantastic now that people can be maintained at home and in the community.
As a member of the Chernobyl Children’s Project, I remember when I started going out to the orphanages back in the mid-1980s, they were so reminiscent of St Mary’s when I started.

Carmel Mulchrone started her training as a psychiatric nurse at St Mary’s Hospital in 1975. She now works at the old St Theresa’s Unit, specialising in continuing care and rehabilitation. She was in conversation with Áine Ryan.

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