This is surely equally true when they are sourced from archival case notes.
Finnane, for example, recounts the case of a young woman in the Richmond Asylum in the early 1890s, who was brought up as an orphan in the workhouse but then went to prison and was later admitted to the asylum.84 According to the asylum case book, she was frightened when she believed she saw three nuns on a ladder beating their own foreheads with stones, and when distressed she believed herself to be dead. Might not this young woman have had good reason to fear nuns, or at least view them as difficult to understand and somewhat strange? And, following a difficult childhood, imprisonment and, now, incarceration in an asylum, was she entirely incorrect to consider herself, in a certain sense, ‘dead’?
At the Central Criminal Lunatic Asylum in 1892, a 34-year-old servant from Dublin was admitted after being charged with the murder of her 8-month-old child. Her previous five children had all died young.85 The asylum’s case book records that, ‘on the morning of the crime, she took the child in her arms and left the house. She wandered off some distance from home, did not know where she was or what she was doing. She imagined that she was followed by a large crowd of soldiers and people’. A distressed young mother in late nineteenth-century Ireland, mourning the loss of her five children, feels persecuted and alone? True, there were no soldiers following her that morning, but surely there is still a very compelling truth in her delusions of persecution? Her feelings of being lost? Her hopelessness?
The ultimate truth about what this or other patients thought about their committal and treatment may lie hidden somewhere in these evolving delusions and hallucinations, or in the patients’ own stories (wherever they may be), or even in the physical objects and personal effects that patients left behind when they died or finally left Ireland’s asylums behind them.86 Some of these objects and possessions are explored with particular power and poignancy in ‘Personal Effects: A History of Possession’ by Irish artist Alan Counihan, focusing on patients’ personal effects found in the attic of a disused hospital building at Grangegorman Mental Hospital in Dublin (later St Brendan’s).87 A profound sense of tragedy is palpable in many of these found objects and images, as is a sense of loss and, more often than one might expect, a real sense of survival, hope and life.
For the historian, the methodological challenges inherent in hearing patients’ voices from the asylums of the past are all opportunities, complicated to navigate but by no means impervious to exploration, and certainly not impossible to understand. As a result, while the voices of patients from the 1800s and early 1900s might presently remain largely unknown, they are certainly not unknowable. Maybe we just need to listen harder and, perhaps, listen better. This book sets out to do so, insofar as possible, with particular focus on case histories and various other accounts and analyses of patients’ experiences inside and outside the asylums.
The Title, Approach and
Structure of this Book
This book is titled ‘Hearing Voices: The History of Psychiatry in Ireland’. There are three reasons for this choice of title. First, ‘hearing voices’ (auditory hallucination) is one of the classic symptoms traditionally associated with mental disorder, so it inevitably features in any history of psychiatry. Second, as I’ve just discussed, this book is an attempt to hear voices that have not often been heard: not only the voices of patients in the asylums, but also those of clinical staff88 who lived their lives behind asylum walls, in circumstances that differed significantly, although by no means completely, from those of their patients.
Third, evolving attitudes towards the experience of ‘hearing voices’ reflect important, iconic changes in psychiatry in recent decades, which I am very keen to highlight. In Chapter 8, I explore the international ‘hearing voices’ movement, which is based on an exceptionally powerful reinterpretation of the experience of hearing voices which used to be routinely associated with major mental disorder but is now subject to more nuanced interpretations, formulated chiefly by those having such experiences themselves (rather than mental health professionals).89 This is an important and arguably iconic shift in the societal approach to such symptoms, and this is an important element of the story that I seek to tell in this book.
From a methodological perspective, there are many possible approaches to my task and to the history of medicine in general, ranging from exclusively medical perspectives, charting the evolution of treatments over time, to exclusively sociological approaches, which prioritise the social and political contexts in which medicine and healthcare develop and are practiced. Like most historical texts, this book lies somewhere between these extremes.
From a thematic perspective, Burnham identified five key ‘dramas’ in the history of medicine, relating to the histories of (a) the healer; (b) the sick person; (c) various diseases; (d) discovery and communication of knowledge; and (e) interactions between medicine and health on the one hand, and society on the other.90 All of these ‘dramas’ are reflected in a variety of ways throughout this book, with particular emphasis on interactions between psychiatry and society, owing to the intrinsically societal basis of the Irish asylums of the 1800s and 1900s, and the social roles commonly foisted upon (and all too often accepted by) psychiatry, no matter how unsuitable those roles are. This regrettable feature of the history of psychiatry is a recurring theme in my story.
Chapter 1 of the book commences by exploring the ‘birth of psychiatry in Ireland’ and covers the Middle Ages and early modern era, Gleann na nGealt and Mad Sweeney (in the twelfth century), and Brehon Law (up to the seventeenth century). The emergence of new forms of institutional care is explored, as are the lives and work of Sir William Fownes and Jonathan Swift, especially in the context of St Patrick’s Hospital, Dublin (1746). Burnham’s ‘drama’ of the healer features strongly in the form of Dr William Saunders Hallaran and the succession of therapeutic enthusiasms for new treatments that emerged in the late 1700s and early 1800s in Ireland, as was also the case elsewhere.
Chapter 2 moves on to examine the growth of the asylums in nineteenth-century Ireland, commencing with the Richmond Asylum (1814) and examining the work of pivotal figures such as Dr Alexander Jackson, Robert Peel (Chief Secretary, 1812–17) and Dr John Mollan at the Richmond. Other notable developments included the Select Committee on the Lunatic Poor in Ireland (1817), the Dangerous Lunatic Act 1838, the Private Lunatic Asylums (Ireland) Act 1842, the 1843 report on the ‘State of the Lunatic Poor in Ireland’, the 1851 census and the 1858 Commission of Inquiry on the State of Lunatic Asylums in Ireland. The ‘drama’ of the patient is explored through the use of archival case records and case studies of restraint, ‘neglect and cruelty’, as well as folie à plusieurs, an unusual psychiatric syndrome which, in these cases, was associated with the killing of family members. This chapter also examines treatments for mental disorder, life and death in the institutions, and the experiences of women in nineteenth-century asylums.
Chapter 3 moves explicitly to the ‘drama’ of the interactions between psychiatry and society, looking at the effects, if any, of the Great Irish Famine (1845–52) on admission rates, workhouses, treatment of the intellectually disabled, and widespread alarm about the alleged ‘increase of insanity in Ireland’ during the late 1800s and early 1900s. This chapter also reflects on why the Irish asylums grew so large; outlines (in detail) psychiatric diagnoses from the archives of Carlow Lunatic Asylum in the late 1800s; explores the histories of Bloomfield (1812) and Hampstead Hospitals (1825); and examines Burnham’s ‘drama’ of the healer by looking at the contributions of Dr Thomas Drapes, Dr Conolly Norman and Dr Eleonora Fleury, a remarkable republican doctor and first woman member of the Medico-Psychological Association (MPA, 1894).
Chapter 3 also presents the case of Mary, a 40-year-old ‘housekeeper’
