Having been funded by a bequest from author Jonathan Swift following his death in 1745, St. Patrick’s Hospital for the Insane, Dublin, opens on September 19, 1757. The hospital is a psychiatric facility located near Kilmainham and the Phoenix Park.

Today, St. Patrick’s University Hospital, known for the innovative care of its patients, provides “Ireland’s largest, independent, not-for-profit mental health services.” When founded in 1745 it is the first psychiatric hospital to be built in Ireland mandated for the care of “Idiots and Lunaticks.”

Although new theories of madness and more therapeutic approaches to treatment are being proposed in the late 1700’s, during most of the eighteenth century society views the lunatic as one who has literally lost his reason, “the essence of his humanity,” and therefore “his claim to be treated as a human being.” Treatments, designed “to weaken the animal spirits that were believed to be producing madness,” still include restraints with chains, bloodletting, emetics, purging, and beating.

Confinement rather than cure is the focus of the earliest institutions in Great Britain. They resemble prisons with cells and keepers to control the inmates. Bethlem Hospital in London is the first to include lunatics in 1377. By the eighteenth century it has become infamous as “Bedlam” and has a reputation for cruelty, neglect, and poor living conditions, with an inadequate diet, rough clothing, and inactivity. Even worse, the mad in Bedlam are displayed as entertainment — a “freak show,” a “spectacle,” a “menagerie” from which “both provincial bumpkins and urban sophisticates could derive almost endless amusement” for a fee.

The earliest biographers of Jonathan Swift report that he had chosen to found St. Patrick’s Hospital because he had become insane himself at the end of his life. One writer even claims that he is the first patient to die there. Neither of these conclusions is accurate. It is his philosophical views and personal experiences that influence Swift’s decision to leave his estate for the establishment of St. Patrick’s.

Throughout the eighteenth century, medicine, politics, and literature all debate the relation between reason and madness, a subject that greatly interests Swift. In his most powerful satires, including Gulliver’s Travels (1726) and A Modest Proposal (1729), he sometimes explores the Lockean theory that “any person could fall into madness by the erroneous association of ideas.”

But the stronger motivation for Swift’s legacy grows from his involvement with the day-to-day problems of the Irish people, not only as an individual but also as Dean of St. Patrick’s Cathedral, a position he holds from 1713 until his death. At mid-century there are no provisions specifically for lunatics. If not being cared for by their families or found wandering the countryside, lunatics would sometimes be confined with criminals in prisons, with the poor in a workhouse, or with the sick in a hospital. Swift has firsthand knowledge of these conditions since he served as a governor of the workhouse and as a trustee of several hospitals. In 1710, after a visit to Bedlam, he gets himself elected a governor there in 1714. By 1731 he has decided on his legacy, intending his hospital to be charitable and more humane than Bedlam.

Another strong motivation may have been Swift’s ability to empathize with the sufferers of madness. Not mental illness but recurring attacks of Ménière’s disease (MD) afflict him for over fifty years, beginning at age twenty-three. The debilitating bouts of vertigo, nausea, tinnitus, and deafness worsen by the late 1730’s, and he complains of memory loss and difficulty in reading and writing. When he finalizes his will in 1740, he refers to himself as sound in mind but weak in body. In 1742, following a sudden decline in his health, his friends have him judged incompetent and appoint a guardian. Probable dementia increases his helplessness until his death on October 19, 1745.

Swift leaves an estate of about 12,000 pounds. In his will he lists details as to where St. Patrick’s should be built and how it should be run by his board of governors. Although they first meet in 1746, the asylum does not open until 1757. The governors need to acquire the site, oversee the plan and construction of the building, and ensure available money for operating expenses. Insufficient funds are the main obstacle, even after adding money from rents, donations, subscriptions and Parliament. Finally, St. Patrick’s has to accept paying patients to offset the costs of its charity cases.

Richard Leeper, who is appointed Resident Medical Superintendent in 1899, introduces a series of important initiatives including providing work and leisure activities for the patients. Norman Moore, who is appointed Resident Medical Superintendent in 1946, introduces occupational therapy, including crafts and farm work to the patients.

After the introduction of deinstitutionalisation in the late 1980s the hospital goes into a period of decline. In 2008 the hospital announces the expansion of its outpatient services to a series of regional centres across Ireland. A mental health facility for teenagers, known as the Willow Grove Adolescent Inpatient Unit, opens at the hospital in October 2010.

The hospital is affiliated with Trinity College Dublin, and has 241 inpatient beds.