child in the mid-1890s. Mary was ‘acquitted on the grounds of insanity’ and detained at the Central Criminal Lunatic Asylum (later Central Mental Hospital, Dundrum) ‘at Her Majesty’s Pleasure’ (i.e. indefinitely). Mary’s admission diagnosis was ‘chronic melancholia’, and examination of her archival case records in this chapter questions the nature of this diagnosis and uses Mary’s story to illustrate diagnostic challenges in the late 1800s, along with difficulties separating mental disorder from social and economic problems, especially among women, during this difficult period in Irish psychiatric history.
Chapter 4 explores ‘early twentieth-century psychiatry’, setting the scene with consideration of the remarkably insightful (but sadly ignored) Reports of the Committee Appointed by the Lord Lieutenant of Ireland on Lunacy Administration (1891).91 Chapter 4 then outlines the fate of the mentally ill outside the asylums in the early 1900s, the Conference of the Irish Asylum Committees (1903) and key issues at the Richmond District Asylum (Grangegorman) in 1907. In terms of the links between psychiatry and broader sociohistorical events, this chapter outlines the effects of the 1916 Easter Rising on Dublin’s asylums; the story of the Richmond War Hospital (1916–19); the remarkable life and career of Dr Ada English, patriot and psychiatrist in Ballinasloe; and the broader relevance of nationalist sentiment throughout the asylum system during Ireland’s revolutionary years.
Again, Burnham’s ‘drama’ of the sick person is explored throughout this material, especially through the case study of Michael, a 35-year-old man committed to the Central Criminal Lunatic Asylum in the 1890s, charged with ‘assault’; declared ‘insane on arraignment’; and diagnosed as a ‘congenital imbecile’. Michael’s story, based on archival clinical records, demonstrates many important features of Irish asylum life in the late 1800s and early 1900s, especially as they relate to persons with apparent intellectual disability. The experiences of the intellectually disabled feature repeatedly (and disturbingly) throughout the story told in this book.
Chapter 5 moves on to examine efforts at reform of Ireland’s mental health services in the early 1900s, looking at multiple sources of evidence including media articles, developments relating to the intellectually disabled, and accounts of industrial unrest (e.g. the Monaghan Asylum Soviet, 1919). Burnham’s ‘drama’ of the healer is explored through the work of Professor John Dunne in Grangegorman and, in relation to occupational therapy, Drs Eamonn O’Sullivan in Killarney and Ada English in Ballinasloe. This chapter also explores therapeutic enthusiasms for some of the most controversial treatments in the history of psychiatry (psychotherapy, malarial treatment, insulin coma, convulsive therapy, lobotomy); the reforming efforts of the Mental Treatment Act 1945 and the Commission of Inquiry on Mental Illness (1966); and, in the independent sector, the development of St Patrick’s Hospital, Dublin during the twentieth century.
Chapter 6 documents the ‘decline of the institutions’ in the late 1900s and explores various factors that contributed to this, including the advent of effective antipsychotic medication, and changing public and press perceptions of psychiatry. The patient’s voice is heard through first-person accounts of psychiatric hospitalisation provided by the Reverend Clarence Duffy (1944) and Hanna Greally (1971).
This chapter also examines Irish psychiatry in relation to homosexuality, explores the remarkably persistent idea that mental illness was more common in certain parts of Ireland than elsewhere, and looks at the figures who led various reforms within Ireland’s mental health services, including, but by no means limited to, Dr Dermot Walsh, Professor Ivor Browne, Dr Des McGrath, Professor Thomas Lynch, Professor Thomas Fahy, Dr Robert McCarthy, Professor Robert Daly, Dr Brian O’Shea, Professor John P. (Seán) Malone, Professor Noel Walsh, Professor Marcus Webb and Professor Eadbhard O’Callaghan. These figures speak not only to Burnham’s ‘drama’ of the healer, but also the emphasis Burnham places on the discovery and communication of knowledge as a key factor in the history of medicine, as well as interactions between psychiatry and broader society.
Attention is also devoted in Chapter 6 to the emergence of military psychiatry in Ireland, the ill-fated Health (Mental Services) Act 1981, the opening of new acute psychiatric units in general hospitals, issues relating to mental health nursing, the 1984 policy, Planning for the Future, and the outstanding contribution of Professor Anthony Clare to psychiatry in Ireland and beyond. Chapter 6 incorporates considerations of the emergent emphasis on human rights in mental health in Ireland and the role of international human rights movements in creating a context for changes in policy, law and social perceptions of mental illness and psychiatry.
Chapter 7 explores the recent history of psychiatry in Ireland in the early twenty-first century, looking at the Mental Health Act 2001; the 2006 policy, A Vision for Change; the development of child and adolescent psychiatry; the Irish Journal of Psychiatry (1982), the Irish Journal of Psychological Medicine (1982) and other professional journals in Irish psychiatry; the emergence of the College of Psychiatrists of Ireland (2009); and the 2015 review of the Mental Health Act 2001. Important service developments are explored, including the ongoing move to community care, the evolution of the National Forensic Mental Health Service and mental health services for the deaf.
The final chapter, Chapter 8, focuses on the future of psychiatry in Ireland in light of the historical analyses presented in earlier chapters, as well as recent data. This concluding section focuses particularly on interactions between psychiatry and society; societal ‘structural violence’ and social exclusion of the mentally ill; postpsychiatry and other reformist movements; suicide; ongoing issues relating to human rights; and likely future developments in clinical, academic and historical psychiatry. The book concludes with a consideration of the overall future of psychiatry in Ireland, based on events and trends over past centuries and informed by the state of psychiatry in early twenty-first century Ireland.
Throughout the book, extensive details of primary and secondary sources are provided for readers who seek further information on any topic. I have devoted particular attention to citing and quoting primary material and cross referencing to the secondary literature, with an especially strong emphasis on publications relating directly to psychiatry in Ireland. It is hoped that this extensive quotation, citation and referencing will assist future researchers.
For the most part, practicing psychiatrists are not discussed in depth, although some are mentioned. For recently retired or recently deceased psychiatrists who are discussed (especially in Chapter 6), it is too soon to present a historically informed, critical appraisal of their contributions. As a result, my accounts of recent figures should not be read as critical, historical analyses of their lives and work, which would be premature at this short remove, but as summaries of their careers and achievements (with some brief comments). Future historians will be better placed to comment critically on the enduring effects of their work, and hopefully the brief accounts presented here will assist in informing such assessments.
Finally, throughout this book, original language and terminology from the past and from various archives and reports have been maintained, except where explicitly indicated otherwise. This represents an attempt to optimise fidelity to historical sources and does not represent an endorsement of the broader use of such terminology in contemporary settings.
1
THE
