on nineteenth-century Ireland, its effects on psychiatry are considered next.
The Great Irish Famine (1845–52):
‘Weak Minded from the Start’
Interestingly, the Great Irish Famine is generally under-represented in the historiography of mental disorder in Ireland. This is likely attributable, at least in part, to the broader literature’s strong focus on the building of asylums which occurred around the same time. There is, however, little doubt that the Famine increased reliance on various forms of social support among the Irish population in general,6 including those with mental disorder,7 as was duly noted by asylum doctors at the time.8 But did the Famine itself actually increase the rates of occurrence of mental disorder?
Evidence from other countries suggests that this is certainly possible: certain cohorts of people, who were in gestation during the Dutch Winter Hunger of 1944 and born shortly afterwards, were found to have twice the risk of schizophrenia in later life compared to those not exposed to famine conditions during pre-birth development.9 This is likely attributable to the effects of hunger and stress on the developing brain prior to birth, leading to altered patterns of brain development in childhood and adolescence and increased risk of schizophrenia in young adulthood.10 Did something similar occur in Ireland during the Famine?
Walsh used data derived chiefly from the Annual Reports of the Irish Inspectors of Lunacy on the District, Criminal and Private Lunatic Asylums, adjusting nineteenth-century diagnostic labels to elucidate, as best as feasible, if the Famine increased rates of schizophrenia in Ireland.11 He found that while there was indeed an increase of 86 per cent in first admission rates for apparent schizophrenia between 1860 and 1875 (when those in gestation during the Famine reached the high risk age for developing schizophrenia), admissions with other diagnoses (chiefly ‘melancholia’) also increased, and similar increases were evident in other jurisdictions over the same period. These results are, therefore, inconclusive.
The absence of any dramatic trend in Walsh’s work is consistent with the views of Torrey and Miller, who suggest that the effect of the Famine on committal rates was minimal, as admissions simply continued to rise steadily during this period anyway.12 Given the devastation wrought by the Famine and the fact that the asylum system had been firmly established by the late 1830s,13 the continued rise in admissions is unsurprising: in times of unprecedented difficulty and distress the asylum offered, at the very least, food and shelter for those in need. In 1844 there were 2,136 ‘mentally ill’ persons resident in public asylums on the island of Ireland and by 1855 this had risen to 3,522.14 This trend, however, continued long after the Famine: by 1900, the number had reached 16,404.
Given these generally increasing admission rates over the course of the 1800s, is there any other way of looking at existing data so as to elucidate further any possible links between the Famine and admission patterns? First, it is useful to note that, although no part of Ireland fully escaped the effects of the Famine, not all counties were affected equally. Counties in the west of Ireland, such as Galway, Mayo and Roscommon, were particularly badly hit: the death rate in County Mayo between 1846 and 1851 was approximately 60 per 1,000, while the death rate in Kildare and Wexford was under 5 per 1,000.15 Western counties had a particular reliance on potato crops, so when the crops failed from 1845 to 1849, western subsistence farmers and their families were especially vulnerable.
Grimsley-Smith, in a fascinating analysis of admission rates over the decades following the Famine, notes a significant and sustained increase in admissions of 20- to-30-year-olds between 1857 and 1868 in Connaught (the area worst affected by the Famine) but not in Ulster, Leinster and Munster.16 She also points to the 1914 report of the Inspectors of Lunatics who examined statistics from this period and concluded, subject to certain caveats, that there seemed to be ‘an exceptional number of insane and idiots derived from the population born during the decade 1841-51’:
It seems probable that children born and partially reared amidst the horrors of the famine and the epidemics of disease that followed it were so handicapped in their nervous equipment as to be weak minded from the start or to fall victims to mental disease later.17
This supports the idea that, in the areas worst affected, the Famine altered early human development in such a fashion as to increase risk of mental disorder later on, in young adulthood. There are, of course, many challenges associated with reaching such a conclusion, not least of which are the potentially confounding effects of concurrent changes in committal practices, rates of co-occurring physical illnesses, patterns of migration, changes in population structure, declining rates of marriage, and various other demographic factors. There are, in addition, great challenges associated with interpreting diagnostic categories from the past and translating them into contemporary diagnostic categories, even on an approximate basis.18
Even in light of these issues, however, it still appears reasonable to conclude that the Great Irish Famine, like the Dutch Winter Hunger, increased risk of mental disorder among persons who were in gestation during the Famine and born during it or shortly afterwards. Other, variously related factors, such as family structure, family conflict and emigration, were also relevant to committal practices in post-Famine Ireland.19 There may also have been transgenerational effects which affected patterns of illness many decades later, and this possibility richly merits, and is the subject of, further study.20
Finally, it is readily apparent that, at the time of the Famine, both starvation and prevailing deprivation acutely increased social need among the mentally ill21 and also likely led to a worsening of psychiatric symptoms among people with pre-existing mental disorder, both of which increased pressure on asylums to admit people with starvation related distress and intensified mental disorder.22
Analogous evidence for the latter is available from studies of the ‘famine’ which occurred in French psychiatric hospitals between 1940 and 1944, when France was under Nazi rule and rations to French asylums were reduced to levels incompatible with life.23 This resulted in increased mortality in French asylums and a sharp intensification of all forms of mental disorder. The philosopher Simone Weil (1909–1943), herself in an English hospital at the time, died of starvation, possibly in solidarity with the conditions endured by her compatriots in France.24
The famine in French asylums was a specific, demarcated phenomenon which only affected individuals already in asylums, at a particular moment in France’s history. Nonetheless, the deterioration in mental health produced by the lack of food in French asylums provides strong evidence that famine conditions have adverse effects on mental health, at least amongst the mentally ill. This was also the case in Ireland, where persons with worsening mental disorder and starvation related distress sought not only to enter the asylums but also the workhouses, which, despite their drawbacks, at least provided a certain level of care for those with nowhere else to go.
Workhouses and the Mentally Ill:
‘Little More Than a Dungeon’
Even prior to the Famine, destitute persons with mental disorder or intellectual disability had commonly been admitted to workhouses and various charitable establishments, especially during times of social or economic difficulty.25 In 1708, the Dublin workhouse built six cells for persons with apparent mental disorder, intellectual disability or epilepsy.26 The number of places increased to approximately 40 by 1729, but conditions were dreadful: the inmates were chained in foul, unglazed, underground cells with little light or freedom.27
In 1787, the Prisons Act empowered Grand Juries (county administrative and judicial bodies) systematically to establish lunatic wards in houses of industry, and dictated that such wards would be subject to inspection by the Inspector General of prisons.28 The wards were to house insane persons or ‘idiots’ who had to be certified by at least two magistrates.29 The initial response to the 1787 legislation was relatively modest, however, and lunatic wards were only established in Dublin, Cork, Waterford and Limerick.30
As
