this time, including syphilis, ‘heredity’, ‘family troubles’, ‘domestic troubles’, ‘love affairs’, ‘pecuniary loss’, ‘betting on race horses’, ‘religion’, ‘fright’, ‘influenza’, ‘phthisis [tuberculosis] and exhaustion’.
Some patients were presented to the asylum through the criminal justice system. In the early 1890s, one man in his early 20s was ‘transferred from Kilmainham jail’ (Dublin) by the authority of the ‘Lord Lieutenant’, with a one week history of ‘mania’ owing to ‘religious delusions’. He spent almost two years in the Carlow asylum before being discharged, ‘recovered’, ‘by order’ of the Lord Lieutenant. A man in his 40s of no fixed abode was admitted from Kilkenny jail at around the same time, with diagnoses of ‘imbecility and mania’; he died in the asylum five months later. A woman with ‘partial mania’ was admitted from Grangegorman Prison (Dublin) and a man in his 40s transferred from the Central Criminal Lunatic Asylum (Dundrum, Dublin), as his sentence had expired. He had previously been in ‘Kilkenny prison’ and spent three months in the Carlow asylum with ‘melancholia’ due to ‘domestic troubles’.
A woman in her 50s also developed ‘melancholia’ due to ‘domestic trouble’ during this period, but her record is notable because it records that she had ‘left insane ear’. ‘Insane ear’ referred to ‘haematoma auris’, a swelling of the ear lobe owing to effusion of blood. Throughout the 1800s, this was thought to be connected with certain forms of insanity including GPI (late stage syphilis, affecting the brain) and epilepsy (especially when associated with mania).190 ‘Insane ear’ was, however, also linked with the use of physical restraint or coercion,191 and this seems a more likely explanation for its reported frequency in asylums.
Various physical causes were commonly cited as reasons for insanity. In the mid-1890s, a ‘housekeeper’ in her late 50s was admitted for two months with a two week history of ‘epileptic mania’, and was also physically ‘debilitated’. A ‘labourer’s wife’ in her 50s was admitted with ‘melancholia’ attributed to ‘sequelae of influenza’; she too was physically ‘debilitated’. One man’s ‘dementia’ was attributed to ‘injury to head’, another’s ‘paranoia’ was linked with ‘possible injury to cranium’, and another man was ‘homicidal and suicidal’ owing to ‘injury of head’. In the late 1890s, a woman was admitted with ‘acute melancholia with delusions’ owing to ‘domestic troubles’ but was also ‘much emaciated’ from ‘tuberculosis’.
Life circumstances were commonly cited as reasons for admission. A case of ‘senile melancholia’ in a ‘servant’ in his 70s admitted from ‘Carlow Union, Carlow’ was attributed to ‘poverty and hardship’; his ‘bodily condition’ was only ‘fair’ and he died six months later. Another man in his 70s had ‘senile mania’ owing to ‘want and age’. A ‘coachman’ in his 40s developed ‘acute mania’ owing to ‘business troubles and loss of sleep’; he had previously been ‘a patient in Mullingar Asylum on two occasions’ and spent three months in the Carlow asylum. A man in his late 20s was admitted with ‘acute mania’ due to a ‘love affair’, while a farmer in his 30s developed ‘melancholia’ also owing to ‘love affairs’.
Some diagnoses appear somewhat curious. In the mid-1890s a ‘servant’ in her late 20s was admitted with ‘mania’ due to ‘overwork’. Around the same time, a ‘well educated’ man in his early 40s spent three months in the asylum with ‘diagnosis’ of ‘insanity doubtful’. The same description was applied to a woman admitted in her 60s during the same period, although she was also ‘debilitated from old age’.
Perhaps the most moving cases relate to women who lost or missed their children. One woman was admitted with ‘mania’ owing to ‘loss of a child’, while a ‘housekeeper’ in her 40s was ‘fretting for a daughter left the country’, and had ‘palpitation of the heart’. Most affecting, however, was the case of a woman in her 50s who was admitted in the mid-1880s with a three month history of ‘acute mania’ owing to ‘her two sons going to America’. This woman was never discharged: she died in the asylum 10 years later.
In 1848, 16 years after the asylum opened in Carlow, building began for ‘Kilkenny District Lunatic Asylum’ (later St Canice’s Hospital), which was formally opened on 1 September 1852.192 Dr Joseph Lalor was the first Resident Physician and manager. The first patient was a 70-year-old woman who had been committed at the age of 30 owing to a nervous breakdown following childbirth. She and 53 other Kilkenny patients were admitted to the new asylum from ‘Carlow District Hospital for the Insane’. They were joined by 47 patients from ‘Kilkenny Local Lunatic Asylum’ (a small local establishment), 24 from the county Kilkenny Prison, and 10 directly from the district.193
Patient numbers in Kilkenny increased rapidly, to 295 in 1880, 440 in 1902, and peaking at 550 in 1939. By the early 2000s, however, numbers had decreased to approximately 100, in line with national psychiatric deinstitutionalisation. In March 2003 a new purpose built acute psychiatric admission unit opened on the site of Kilkenny General Hospital resulting in significant improvements in care and a sharp contrast with the district asylums of the 1800s and 1900s.194
From an historical perspective, the litany of diagnosis from Carlow in the 1880s and 1890s shows the diversity of cases that presented to the asylums during that period and the inventiveness of some of the diagnoses applied. Similar diagnoses were described in Portlaiose,195 Sligo196 and elsewhere.197 The records of discharges are also interesting, and, even if some discharges were followed by readmission, they still provide evidence of a desire to minimise asylum stays and avoid the institutionalisation that so concerned asylum staff and broader society at this time.
Asylums, Friends and Religious Involvement in
Mental Health Care
One of the outstanding features of the history of psychiatry in Ireland, and the emergence of the asylum system in particular, is the limited role played by the Roman Catholic Church in developing services for the mentally ill.198 While there was some accommodation for the mentally ill in the early Irish monasteries, this was always very limited in scope and the dissolution of the monasteries in the mid-1500s diminished it even further.199 Following this, the Roman Catholic Church remained generally uninvolved in formal mental health care, apart from providing chaplains to the asylums – and even this was not without controversy in, for example, Belfast.200 This was the position up until the late-1800s and mid-1900s when certain organisations (e.g. Daughters of Charity, Brothers of Charity, Brothers of St John of God, Sisters of La Sagesse and Sisters of Jesus and Mary) became central to the provision of services to the intellectually disabled, building on the histories many of these organisations had in this field.201
The late 1800s and early 1900s also saw increased involvement of locally powerful Catholic figures on asylum boards in certain locations, such as Carlow202 and Cork,203 but, notwithstanding these local developments, the Roman Catholic Church never attained, or sought, a dominant, national position in mental health care similar to that it assumed in general healthcare and education.
There were, nonetheless, specific initiatives, chiefly relating to specific religious orders. In 1882, the Brothers of St John of God established a private psychiatric hospital in Stillorgan, County Dublin (Chapter 6).204 St Vincent’s Hospital in Fairview, Dublin is another one of the relatively few examples of a Roman Catholic organisation, the Daughters of Charity of St Vincent de Paul, becoming involved in mental health care in Ireland.205 St Vincent’s was founded in 1857 following the bequest of Francis Magan, a barrister and member of the United Irishmen (an Irish republican organisation) whose fortune had resulted from his informing on the leader of the 1798 rebellion, Lord Edward Fitzgerald (1763–1798).206 When Magan’s sister died, the fortune was used to found a hospital in Fairview for mentally ill Catholic women and men, although only the female side progressed. In 1857 the hospital had seven patients;
