ten days previous’. At his trial, Patrick was charged with murder and detained indefinitely at the Central Criminal Lunatic Asylum. Clinical notes record that he ‘recovered from the attack of acute mania from which he suffered while in [prison] and for some days previously; he accounts for the insanity in his family (which occurred almost suddenly) being brought on by “something” they all partook of while at meals, but is unable to say what the nature of this “something” was. He recognises perfectly the crime that both he and his brothers committed and is fully aware that he was at the time “out of his mind”. He has a somewhat down-cast appearance, a slow slouching gait and is depressed in manner and appearance’. He ‘never presented any symptoms of insanity’.
Patrick’s younger brother, John, was admitted on the same day in 1896 with a very similar history. John was diagnosed with ‘acute delusional mania, convalescent’ and he, like Patrick, soon ‘recovered from the attack of acute mania from which he suffered at the time of committing the murder of his brother and afterwards while in [prison]. Patient is very quiet and well-conducted, is in fair health, takes his food well and sleeps soundly. Has been sent with his brother [Patrick] to work on the land and they are both satisfied and pleased to do so’.
Later in 1896, a third brother, Brendan, was also charged with the murder of his brother and detained ‘at the Lord Lieutenant’s pleasure’. Admission notes describe Brendan as ‘very quiet, well-spoken and most respectful; both in manner and appearance he much resembles his brothers … He presents no symptoms of insanity. I consider him perfectly sane; but like his brothers he suffered from an attack of acute mania while in [prison] … He is quite unable to in any way account for the insanity which occurred in his family, he feels deeply the great misfortune which has befallen them and is depressed when speaking of his brother … who was the unfortunate victim of their insanity’.
On admission, Brendan had a history of ‘phthisis’ (tuberculosis) which worsened in the hospital. In 1897, the medical officers wrote to the Inspector of Lunatics stating that Brendan was ‘suffering from effects of detention and presents symptoms of incipient phthisis. We strongly recommend his discharge on the grounds that his disease will be aggravated by his detention’. Despite treatment with cod liver oil, medical notes recorded that ‘phthisis makes itself more evident each day’. The medical officers again wrote to the Inspector of Lunatics stating that Brendan’s ‘condition has become critical and that if he is to be discharged, he should be released at once, as in our opinion, he will soon become too ill to be removed. His temperature at night has reached 102 [º Fahrenheit (39º Celsius); i.e. raised] and in our opinion he will not survive this winter’. After two more weeks, Brendan was discharged to the care of his sister, but died three months later, in late 1897.
Neither Patrick nor John showed any convincing signs of mental disorder during their time at the Central Criminal Lunatic Asylum. In 1898, the medical officer sent a report to the Inspector of Lunatics stating that both brothers were ‘suitable for discharge. They both have been industrious and extremely well behaved since admission here. The only distinction I wish to make is that detention is having a bad effect on John’s health and he may become ill in the same manner as his brother Brendan, who died soon after his being released from here’. Four months later, the medical officer sent an additional report stating that John was now ‘in very delicate health and threatened with phthisis and we consider that he will die from this disease if not discharged soon. We also certify that he may be discharged with safety to himself and others’. Later that year, John was ‘discharged in care of sister’ and three years later Patrick, too, was discharged ‘in care of his sister’, after more than five years in the asylum.
Overall, these cases demonstrate clear forensic complications of folie à plusieurs, involving, in this case, the killing of a family member. These cases occurred in the 1890s, just a decade after the clinical syndrome of folie à plusieurs had been described in detail by Ireland in his collection of clinical vignettes illustrating both clinical and forensic aspects of the syndrome.319 Three years after Ireland’s publication, Dr Daniel Hack Tuke, formerly of the York Retreat,320 also published a detailed account of folie à deux or ‘double insanity’ in the respected journal Brain.321
These cases of the three brothers are particularly interesting in light of indications that they suffered from an acute physical illness with delirium, which accounted for their delusions and other psychiatric symptoms. Their treatment in hospital was described as ‘moral supervision and dietetic’, an approach which involved regular exercise, gainful employment and an emphasis on healthy diet,322 all of which were consistent with the principles of ‘moral management’.323 Other activities the Central Criminal Lunatic Asylum during this period included were ball games, dancing, music, evening parties and reading books and newspapers (although many patients were unable to read).324
These cases also demonstrate the problems with tuberculosis (‘phthisis’) in the Irish asylums in the late 1800s and early 1900s:325 at least one of the three brothers, Brendan, died of the disease. Interestingly, one of the other brothers, Patrick, contended that their illness was ‘brought on by “something” they all partook of while at meals, but is unable to say what the nature of this “something” was’. This is consistent with evidence from another case of folie à plusieurs described by the remarkable Dr Oscar T. Woods, medical superintendent of the Killarney Asylum, in 1889 and, later, president of the MPA,326 in which bad food was also seen as a contributory cause.327
Overall, the cases of the three brothers demonstrate many of the challenges that ‘communicated insanity’ presented to mental health and judicial services in nineteenth-century Ireland and which remain relevant in the 2000s. Over a century after these cases, the optimal balance between punishment and treatment still continues to be difficult to achieve in contemporary mental health services,328 and both treatment329 and community reintegration present ongoing challenges, especially in cases with substantial forensic dimensions.
Women and Mental Illness in
Nineteenth-Century Ireland
Women with mental disorder were treated differently than men throughout the nineteenth and twentieth centuries by the Irish criminal justice and psychiatric systems.330 Following committal to the Central Criminal Lunatic Asylum in Dundrum, for example, women generally experienced shorter periods of detention and were more likely to be discharged than men.331 This might be attributable to the nature of offences committed by women: 54 per cent of women detained at the Central Criminal Lunatic Asylum between 1868 and 1908 (a total of 70) were charged with or convicted of killing, of which a majority (70 per cent) involved child killing.332
Issues related to menstruation, pregnancy and childbirth were significant factors in determining how these women were viewed in many jurisdictions, including Ireland.333 Parry writes that Hallaran’s ‘emphasis [in 1810] on childbirth and menopause as factors which led to insanity in women was the beginning of what would become medical orthodoxy – the link between female biology and insanity. The work of Thomas More Madden, at the end of the century, shows how this opinion of the causes of insanity had gained wide acceptance. Madden, who was physician to St Joseph’s Hospital, Dublin, argued forcefully that insanity in women was caused by their reproductive capacity’.334
In a similar vein, Dr Fleetwood Churchill wrote, in the Dublin Quarterly Journal of Medical Science in 1850, that cyclic changes in bodily health affected women more than men, with consequent effects on mental activities, and that menstruation, conception, pregnancy and childbirth could all produce disturbances which could amount to insanity.335 In Great Britain, Dr Henry Maudsley (1835–1918) agreed, pinpointing irregularities of menstruation as known causes of mental disorder which could generate suicidal or homicidal impulses.336
Similar emphasis was placed on menstruation as a cause of mental disorder or disturbed behaviour in the US.337 In 1865, one female defendant was found insane at the time of a particular shooting owing to apparent insanity resulting from a combination of romantic problems and dysmenorrhea.338 Dr Isaac Ray (1807–1881),
