Hearing Voices. Brendan Kelly
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St Vincent’s expanded substantially throughout the 1800s, and underwent further developments in 1932, 1978 and 1993. By 1997, St Vincent’s had 97 inpatients and there were 1,074 admissions and 1,073 discharges (and two deaths) over the previous twelve months.208 There were also 14 patients in St Aloysius Ward, which opened in October 1994 in the Mater Misericordiae University Hospital, one of Dublin’s major general hospitals founded in 1861 by the Sisters of Mercy.209 Both of these developments in mental health care, at St Vincent’s and the Mater, found their backgrounds in the Catholic organisations that operated the establishments.
Overall, however, while certain Catholic organisations became involved in specific initiatives within mental health care (e.g. a Child Guidance Clinic was opened at the Mater in 1962),210 it remains the case that the official Roman Catholic Church is notable by its general absence from the history of the systematic provision of psychiatric services in Ireland. While certain people with psychological problems undoubtedly sought individual guidance from the Church and from priests or other religious, the Church itself did not become systematically involved in formal mental health services. As a result, the Irish asylums were very much State institutions rather than Church ones.
This is intriguing: the Roman Catholic Church was deeply involved in Irish politics, general (i.e. physical) healthcare and education, but did not develop formal, systematic initiatives in mental health care. The reasons for this are complex (and in need of further study) but likely relate, at least in part, to the Church’s attention to other areas (e.g. medical care, schools) rather than mental health care, and the prominent involvement of figures from other religious traditions in early Irish mental health care, most notably Jonathan Swift, an ordained priest in the Established Church of Ireland who bequeathed his entire estate to establish the hospital for ‘idiots and lunaticks’ that later became St Patrick’s Hospital, the first formal asylum in Ireland.211
The Religious Society of Friends (‘Quakers’) was another religious group that developed a strong association with early mental health care, exemplified by the establishment of The Retreat at York in England in the 1790s.212 In Ireland, representatives of the Yearly Meeting of Friends in Ireland, along with some other Friends, met on 29 April 1807 to consider providing accommodation for the mentally ill.213 Three years later they bought Bloomfield in Donnybrook, Dublin, a house formerly occupied by Dr Robert Emmett, State Physician and physician to St Patrick’s Hospital.214 On 16 March 1812, the first patient was admitted to Bloomfield.215 Among the sources of funding were the proceeds from the sales in Ireland of the works of Henry Tuke (1755–1814), eldest son of William of The Retreat. There was also Quaker involvement in other early initiatives in Cork.216
On 15 May 1815, John Eustace (1791–1867) arrived at Bloomfield as lay superintendent and, two months later, received permission to continue medical studies in Trinity.217 Eustace served as physician to the Cork Street Fever Hospital and, in 1825, opened up an Asylum and House of Recovery for Persons Afflicted with Disorders of the Mind at Hampstead in Glasnevin, Dublin.218 Accommodation at Hampstead was relatively luxurious and surrounded by 1,200 acres of land. Treatments focused on therapy in the garden and farm, among other interventions. Eustace departed definitively from Bloomfield in 1831.
Moral treatment continued to the fore at Bloomfield, actively informed by the ongoing development of practices at The Retreat.219 A second wing was built in 1830220 and, between 1863 and 1912, some 537 patients were admitted.221 The 1900s saw various further developments at Bloomfield and by 1997 the accommodation comprised 60 beds, albeit with just eight admissions over the previous year.222 At that point, 49 patients at Bloomfield were voluntary and 11 were Wards of Court. Standards of hygiene, decor and ‘patient care were of a very high order’, according to the Inspector of Mental Hospitals. Medical services were provided by two general practitioners and there were psychiatric consultations by two old age psychiatrists.223
In 2005, Bloomfield moved from Donnybrook to Rathfarnham, Dublin. Ten years later, this 114 bed hospital was offering a range of specialist services including mental health treatment and care for older adults; services for persons with acute, serious and enduring mental health disorders; complex mental health issues associated with neuropsychiatric disorders and dementia; and a memory clinic.
In parallel with the evolution of Bloomfield, Eustace’s Hampstead Hospital developed and expanded throughout the 1800s, based on the idea that care should be offered in a comfortable, family setting. Highfield Hospital was opened for female patients and in 1888 the remarkable Dr Richard Leeper gained his introduction to psychiatry there when he was appointed Resident Physician at Hampstead and Highfield.224 Leeper held this positon for three years before going on to a long and distinguished career, including becoming Medical Superintendent at St Patrick’s Hospital in 1899 (Chapter 5).225 The services at Hampstead and Highfield evolved further throughout the 1900s and by 1997 there were 42 female patients in Highfield (including two Wards of Court) and 41 patients at Hampstead (including two Wards of Court), and, the Inspector noted, the ‘standard of care, hygiene and décor were high’.226
By the early 2000s the Eustace family had been providing mental health care at Hampstead and Highfield for six generations over almost two centuries, becoming such a part of the fabric of Dublin that they were mentioned in James Joyce’s Ulysses in 1922.227 In 2015, ‘Highfield Healthcare’ was providing specialist care to the elderly across four facilities, with a total of 313 beds. An adult acute psychiatry unit had also been developed. Throughout its fascinating history, the organisation maintained a core commitment ‘to providing the highest standard of care and support to all our residents’ in ‘an environment appropriate to their needs, where the priority is to preserve their dignity and promote their independence’.
Overall, in terms of the role of the Roman Catholic Church in Irish mental health care, it is clear that while certain Catholic groups became involved with specific developments (e.g. St Vincent’s in Fairview, the Mater Hospital services, St John of God Hospital and various services for the intellectually disabled), the Roman Catholic Church itself did not develop a systematic, formal or dominating involvement in the field as it did in relation to general hospitals and schools. For many decades, then, the key role of the Roman Catholic Church in Irish mental health care lay chiefly in the provision of chaplains to the state run asylums that emerged in the 1800s and early 1900s.
That is not to say that the Church was entirely without influence: the specific initiatives described above were both substantive and innovative, and priests were often significant figures in shaping and informing care.228 But it is worthy of note that the field of mental health care in Ireland, unlike the fields of general healthcare and education, was not dominated by the Roman Catholic Church and that the asylums were, for the most part, not religious institutions. As a result, there was plenty of room for developments and innovations by others within the asylum system, including other religious traditions, such as the Society of Friends, and individual clinicians, such as the singular Dr Conolly Norman of the Richmond Asylum in Dublin.
Dr Conolly Norman:
Reforming Doctor
Conolly Norman (1853–1908), the leading psychiatrist of his generation, was born on 12 March 1853 at All Saints’ Glebe, Newtown Cunningham, County Donegal. He was the fifth of six sons of Hugh Norman, rector of All Saints Church, and Anne Norman (née Ball). Norman was educated at Trinity College Dublin, the Carmichael School of Medicine (North Brunswick Street) and the Richmond Hospital. He received the licences of the Royal College of Surgeons in Ireland, King and Queen’s College of Physicians in Ireland, and Rotunda Hospital in 1874. He was elected fellow of the Royal College of Surgeons in Ireland in 1878 and member of the King and Queen’s College of Physicians in Ireland in 1879; he became a fellow of the latter in 1890.
Norman