medical work on the mentally ill, both Fleury and English, like Lynn, Price and Thornton, were deeply concerned about the medical and social wellbeing of the disadvantaged, and consistently linked this concern with the need for political and social change. The decision of these women to enter medicine in the first instance was likely linked, at least in part, to their personal awareness of health and social problems during their childhoods. Their continued awareness of the social context of medicine was likely deepened by their medical training, growing political awareness, experiences in the practice of their profession, and contacts with other woman practitioners.
To this extent, these women were living embodiments of the views of Rudolf Virchow (1821–1902), the German pathologist and politician, who declared that ‘medicine is a social science, and politics nothing but medicine on a large scale’.294 The lives and contributions of Fleury, Lynn, Price, Thornton and English certainly supported the truth of Virchow’s statement, and their pioneering work demonstrated the power of combining medicine with revolutionary politics at a time of exceptional challenge and opportunity in Irish history.295
Psychiatry and Society in the 1800s:
‘A Distant, Deviant Other’
Throughout the 1800s, the development of psychiatry in Ireland, as elsewhere, was largely shaped by the society in which the discipline evolved and came of age. From this perspective, the Famine was undoubtedly one of the defining events of the century, as people with worsening mental disorder and starvation-related distress sought to enter workhouses and asylums in unprecedented numbers.
The Famine may have also shaped the epidemiology of mental disorder in Ireland for several further generations if, as seems likely, it both increased risk of mental disorder in persons who were in gestation at the time (and born during or shortly after the Famine) and had transgenerational effects on patterns of illness many decades later, possibly through epigenetic change (i.e. changes in the ways genes are expressed, rather than changes in genes themselves).296 This possible impact of the Famine on mental disorder both requires and merits further study, just as the Famine’s possible (although likely quite different) impact on the epidemiology of cardiovascular disease has been similarly raised in recent years.297 These areas merit closer study.298
It is already clear, however, that the presence of large numbers of mentally ill persons in workhouses presented very real problems during the 1800s. The Irish workhouses were chronically overcrowded, deeply unsanitary and grossly unsuited to the needs of the destitute mentally ill or intellectually disabled. Nonetheless, the nineteenth century saw workhouses become de facto elements of the system of ‘care’ for the mentally ill,299 as patients were commonly admitted from workhouses to asylums,300 and discharged from asylums back to workhouses.301
The intellectually disabled, much neglected in most historical studies, were also much neglected during this period, with the result that their fate was often similar to that of the mentally ill: there was minimal dedicated provision for their needs, and they either lived at home, became homeless or were admitted to workhouses or, increasingly, the growing number of asylums for the mentally ill.302 As a result, the experiences of the intellectually disabled were in many cases similar to those of the mentally ill who tended to experience lengthy periods of detention in poorly therapeutic facilities, poor mental and physical health, and a high risk of dying in asylums.303
Certain practitioners, such as RMS Drapes of the Enniscorthy District Asylum, sought to improve matters though relatively enlightened asylum management,304 but these efforts were continually hampered by the seemingly inexorable ‘increase of insanity in Ireland’,305 as the number of ‘mentally ill’ persons in Irish institutions increased from 2,097 in 1829 to an astonishing 17,665 in 1894.306 As Walsh notes, ‘between 1880 and 1900 the number of asylum beds in Ireland doubled and between 1860 and 1900 the numbers of admissions, whether first admissions or not first admissions, increased four-fold’.307 Why?
It is, in summary, clear that a number of different factors contributed to the growth of the Irish asylums, including increased recognition of mental disorder; the search for professional prestige among asylum staff; mutually reinforcing patterns of asylum building and committal, underpinned by continual, restless legislative change; changes in diagnostic practices throughout the 1800s; and possible epidemiological change, although there is insufficient evidence to conclude that there was any true increase in the occurrence of new cases of mental disorder to justify the increase in admissions.308
Ultimately, the Irish asylums were primarily social rather than medical creations, expanding to meet societal and community requirements, rather than demonstrated medical needs. They were, however, constantly accompanied by a certain rhetoric about psychiatric and social care,309 care that was deeply needed (and, often, provided) for many patients; was clearly excessive for others; and was utterly inappropriate for some other unfortunate individuals who were simply fed into the system by a society that saw few alternative, non-institutional options for them. The asylums were, to an extent, necessary at the time, but they were also excessively large, commonly misused and ultimately counterproductive for both the mentally ill and society in general. They were an unmitigated disaster for the profession of psychiatry in Ireland, which was to be haunted and defined by the idea of custodial asylum care for several generations to follow.
Nonetheless, the asylums contributed significantly to the emergence of psychiatry as a profession, a process that took a significant step forward when the annual meeting of the Association of Medical Officers of Asylums of Great Britain and Ireland took place in Dublin on 22 August 1861, with Lalor as president.310 The asylums were also intriguing reflections of a complex, conflicted society, and, in this light, one of the most remarkable features of their history is, as already discussed, the virtual absence of the Roman Catholic Church from the story. Apart from its involvement in specific initiatives, the Church and its associated organisations simply did not concern themselves with systematic or large scale provision of mental health care in nineteenth- or twentieth-century Ireland. This contrasted sharply with the Church’s dominant involvement in general healthcare and education, and means that Ireland’s asylums for the mentally ill were, for the most part, State institutions rather than religious ones.
Against this background, throughout the 1800s there was plenty of room for development and innovation in this field by actors other than the Church, including other religious groups such as the Society of Friends and various individual clinicians, such as Norman of the Richmond, who championed ‘family care of persons of unsound mind’.311 Like many reform-minded doctors, however, Norman found that his enlightened initiative did not find favour with governmental authorities. Many of Norman’s other ideas did, however, bear significant fruit, including his nomination of Fleury for membership of the MPA in 1893.312
Other professional developments during the 1800s included increased emphasis on the treatment of mental disorder in professional medical circles. In June 1844, for example, the College of Physicians was notified that Sir Edward Sugden (1781–1875), later Lord St Leonards, Lord Chancellor of Ireland, had decided to give 10 guineas annually as a prize for the best essay on the treatment of mental disorder,313 having also sought to establish a school for the treatment of mental diseases at St Patrick’s.314 The prize was to be awarded for the following 10 years alternately by the College of Physicians and the College of Surgeons, and it duly stimulated much needed interest in the subject.
Throughout this eventful period in the history of Irish psychiatry, it is unsurprising that the asylums and issues related to mental disorder were a staple feature in the popular press, and subjects of much public discussion.315 O’Neill, in a fascinating study of the ‘portrayal of madness in the Limerick press’ from 1772 to 1845, notes that newspaper accounts of mental disorder and its treatment were influenced by a relatively broad range of factors and not simply a desire to convey information in an impartial and informative fashion:
For newspapers in Limerick, accounts of madness – even accounts with an explicit moral or educational intent – were subsidiary to
