century – and this despite the introduction of psychopharmacological agents that supposedly reduce suicidality. So, before we pat ourselves too smugly on the back for the wonderful progress we’ve made in reducing ‘institutionalisation’, let us keep in mind that these old, and today much maligned, asylums did serve a social purpose that we have been unable to replace.
This, therefore, is the story of Irish psychiatry, told by a scholar who is both a historian and a clinician, and has both skill sets. The book is an exhaustively researched look at the past; it concludes with a speculative glance at the future of Irish psychiatry, and is well worth the price of admission for those interested in Irish mental health issues in the present.
Prof. Dr Edward Shorter, PhD FRSC
Jason A. Hannah Professor of the History of
Medicine and Professor of Psychiatry
Faculty of Medicine, University of Toronto
PROLOGUE
In 1905, a brother-in-law of Irish writer, Sean O’Casey, was committed to the Richmond District Lunatic Asylum at Grangegorman in Dublin, part of the vast network of mental hospitals that sprawled across Ireland for much of the 1800s and 1900s. ‘Benson’ (not his real name) suffered from general paralysis of the insane (GPI), a neuropsychiatric disorder caused by late-stage syphilis which often presented with psychiatric symptoms. Commonly fatal, GPI was a substantial problem in asylums in Ireland1 and elsewhere.2
‘Benson’ died in Grangegorman two years later, leaving a widow and five young children.3 In his autobiography, Drums Under the Window, O’Casey described ‘Benson’s’ initial arrival at Grangegorman in vivid, affecting terms:4
Between the keepers, with Sean opposite to see him safe home, Benson, grinning helplessly, was driven to the house of strident shadows, to dress in the rough grey tweed of the loony pauper, to wear the red woollen neckerchief so tied that when one became restless, a keeper could seize it, pull, and choke all movement, quench all fire out of the gurgling, foam-lipped madman; to where he would be dust to dust and ashes to ashes before he was dead, withered grass that hadn’t yet been cast into the oven, to Grangegorman. Wide gates of heavy, dull, heartless lead opened to let them in, and the black cab rolled silently along the drive, drawn by a horse with a sly and regular trot as if he felt and feared anything else might entitle him for companionship with the dread life of the still-twitching dead. Dotted here and there in the grounds were the dismal brothers of disorders grey, their red mufflers making them look as if their tormented heads had been cut off, and pushed crookedly back on to their necks again. The cab stopped slowly before the building, wide and long, built like a bully that had suddenly died shrugging his shoulders. Long rows of lifeless windows mirrored long rows of lifeless faces, their silence hymning a fading resurrection of Velazquez’s idiots5, a whole stonily-grinning gallery of God’s images turned to dull grey clay, the emptiness of a future age in every face. Now and again, some of them would vent a laugh that rippled a shudder along the walls of the asylum. The grass everywhere grew brown and long, and fell to dust whenever it was touched; the trees twisted their branches like limbs in pain, and grew grey leaves that never seemed to move, a cold immortal grey, as if under the blight of the fig tree Christ had cursed. Flowers that tried to grow beneath the windows were slimy stalks, crawling along the grey ground like slugs tantalizing the rim of a festering lily, lost amid the quiet storm of lunacy distilling a sour air everywhere. In a corner a chestnut tree dropped worm-worn fruit like leaden balls, and riven church bells rang out a raucous angelus three times a day, carolling rakishly mid the mindless chatter and the rasping laugh. Only ghosts of things and men were here …
INTRODUCTION
The history of psychiatry is a history of therapeutic enthusiasm, with all of the triumph and tragedy, hubris and humility that such enthusiasm brings. This book presents this history in the very particular context of Ireland, and tells the story of early psychiatric care, the emergence of Ireland’s remarkable asylum system in the 1800s, its demise in the 1900s, and the development of ‘community care’. It is an extraordinary tale.
What is Psychiatry?
Psychiatry, according to Professor Anthony Clare (1942–2007; Chapter 6), one of the outstanding Irish figures in its history,1 is ‘the branch of medicine that is concerned with the study and treatment of disorders of mental function’.2 More specifically, a medical disorder is a disease or ailment,3 and a mental disorder, according to the World Health Organisation (WHO), is a clinically recognisable group of symptoms or behaviours associated in the majority of cases with distress and with interference with personal functions.4 If personal dysfunction is not present, social deviance or conflict on their own are not sufficient to constitute mental disorder: the person’s mood, thoughts, judgement, relationships or personal function must be disturbed.
Throughout history, the evolution of this concept of ‘mental disorder’ has been, and continues to be, a highly contested process.5 Mental disorders are variously conceptualised as spiritual or religious manifestations, legal conundrums, medical diseases, social issues, or all of the above, with the balance between competing conceptualisations varying over time.6 In recent decades, re-definition and expansion of diagnostic categories within psychiatry have proven especially controversial.7
This book, however, is a history of psychiatry rather than a history of mental disorder, madness, the mentally ill, asylums or even psychiatrists.8 Of necessity, all of these concepts feature strongly in the story, but this book is primarily a history of, to use Clare’s definition, that ‘branch of medicine that is concerned with the study and treatment of disorders of mental function’. It is, quite simply and quite complicatedly, a history of psychiatry in Ireland.
Why Write a History of
Psychiatry in Ireland?
In March 1817, Robert Peel (1788–1850), Chief Secretary, prevailed upon the House of Commons of the United Kingdom of Great Britain and Ireland to set up a Select Committee to look into the need to make greater provision for ‘the lunatic poor in Ireland’.9 The Right Honourable Denis Browne (a Mayo Member of Parliament) gave evidence about the plight of the mentally ill in rural areas of early nineteenth-century Ireland:
There is nothing so shocking as madness in the cabin of the peasant, where the man is out labouring in the fields for his bread, and the care of the woman of the house is scarcely sufficient for the attendance on the children. When a strong young man or woman gets the complaint, the only way they have to manage is by making a hole in the floor of the cabin not high enough for the person to stand up in, with a crib over it to prevent his getting up, the hole is about five feet deep, and they give the wretched being his food there, and there he generally dies. Of all human calamity, I know of none equal to this, in the country parts of Ireland which I am acquainted with.10
When presented to the Select Committee in 1817, this picture – the mentally ill person kept in a pit until he or she dies – was a searing one and it still retains its power to shock today, some two centuries later. This image and the reaction it evokes highlight the importance of the history of psychiatry in Ireland. Can an examination of this history help us to understand why such a situation was allowed to develop? How did matters change (if at all) following a seemingly endless succession of official reports such as that of the 1817 Select Committee? Did the emergence of psychiatry in the 1800s improve matters? How much of this situation was specific to Ireland and how much was continuous with the broader, international histories
