The architecture of psychological management: the Irish asylums (1801-1922)

"Dyspepsia," "seduction" and "violent hysteria": reports, reforms and the Irish asylums of the 1850s

While many countries developed asylums for the mentally ill during the nineteenth century, Ireland's asylum system grew faster than those elsewhere, was larger in size and was slower to decline. This paper focuses on two reports central to this process in the 1850s: the 1854 "Report on the status of disease" and the 1858 "Report of the commissioners of inquiry into the state of the lunatic asylums and other institutions for the custody and treatment of the insane in Ireland." In 1854, the "Report on the status of disease," based on the 1851 census, was published, co-authored by Dr. William Wilde, now best known as father of Oscar. Wilde, however, was also a prominent surgeon and author of works on medicine, archaeology and folklore. He was knighted in 1864 owing in large part to his work on the census, which highlighted an apparently high rate of mental illness with such diverse causes as "dyspepsia," "seduction" and "violent hysteria." Four years later, in 1858, the "Report of the commissioners of inquiry into the state of the lunatic asylums and other institutions for the custody and treatment of the insane in Ireland" added fuel to the fire by reporting that "the lunatic asylums of Ireland wear more the aspect of places merely for the secure detention of lunatics than of curative hospitals for the insane." Reform, it seemed, was urgently needed. This contribution examines these two key reports in the fevered, panicked context of Ireland's perpetual reform and expansion of its nineteenth-century asylums.

The Great Irish Famine (1845-52) and the Irish asylum system: remembering, forgetting, and remembering again

The Great Irish Famine (1845-52) saw the Irish population fall by 20% as one million people died and another million emigrated. The Famine occurred at a time when the Irish asylums were growing rapidly anyway, so its precise effects on mental health are difficult although not impossible to study. Three groups merit consideration. First, for adults living through the Famine, starvation and poverty contributed to the continued rise in asylum presentations. Second, babies in utero during the Famine were reported to have accounted for an increase in first admissions when they reached the high-risk age for mental illness (1860-75). Third, the possibility of epigenetic effects (inherited changes in gene expression) as a result of Famine has been discussed as a possible mechanism whereby Famine survivors might have passed on experiences of physical and psychological trauma to their children and subsequent generations in a lasting, biological way. Intriguing as it is, this hypothesis requires further study, as does the distinctly uneven historiography of the Famine in relation to the Irish mental hospitals.

Beyond the walls: the mentally ill in Ireland outside the institutions in 1901

Objectives

Ireland’s rates of psychiatric institutionalisation increased rapidly throughout the 1800s and early 1900s. This paper provides a systematic analysis of individuals with mental illness who were not resident in psychiatric hospitals, workhouses or other institutions in 1901.

Methods

We examined the online census records of all individuals described as ‘lunatics’ on the island of Ireland, not resident in psychiatric hospitals, workhouses or other institutions on census night, 1901.

Results

There were 482 individuals described as ‘lunatics’ and not resident in psychiatric hospitals, workhouses or other institutions on 31 March 1901, yielding a point prevalence of 10.6 per 100 000 population. The lowest prevalence (7.8) was in Leinster (possibly owing to provision of workhouses and asylums); the highest prevalence was in Connaught (17.5) (p=0.013). A majority of them (60.4%) were women. Mean age was 45.7 years. In addition, a majority were single (never married) (63.7%); 33.3% of women were married, compared with 14.1% of men (p<0.001). The most common relationship to the head of the household was child (32.8%), although some were boarders or lodgers. The majority were Roman Catholic (82.0%) and could ‘read and write’ (64.5%). Among those for whom ability to speak Irish was recorded, 74.4% spoke both Irish and English.

Conclusion

There were significant geographical and gender differences within the population recorded in the 1901 census as mentally ill and outside institutions. This group merits further study, especially with regard to their distribution in relation to asylum locations, and the extent to which they were cared for in communities, possibly prefiguring later models of community care.

Dr Ada English: patriot and psychiatrist in early 20th century Ireland

Dr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.

Folie a plusieurs: forensic cases from nineteenth-century Ireland

Folie a plusieurs is a syndrome in which two or more individuals share symptoms (e.g., delusions). This paper uses archival material to present and discuss forensic psychiatric cases of folie a plusieurs from nineteenth-century Ireland. The cases of three brothers who all 'became insane at the same time' and killed another brother illustrate: the role of organic factors in folie a plusieurs; the use of 'moral management' strategies; and the problem of tuberculosis in asylums. The case of one woman whose family 'all became insane at once' and killed one of her sons illustrates: the importance of identifying the 'primary' patient; the difficulties experienced by 'secondary' cases; and the limited therapeutic progress achieved in nineteenth-century asylums. While further historical study is required to explain the emergence of the concept of folie a plusieurs in the late nineteenth century, it is clear that, over one hundred years since the term came to prominence, 'communicated insanity' still presents substantive diagnostic, clinical and ethical challenges to mental health and judicial services.

Learning disability and forensic mental healthcare in 19th century Ireland

The Irish College of Psychiatrists recently reported that "the needs of people with learning disability and offending behaviour pose a huge challenge to service providers. The vulnerability of people with a learning disability who come into contact with the criminal justice system is well described and noted." The College noted that "the population with learning disability who offend does not easily fit into existing services" and reported that "the majority of service providers strongly supported the urgent development of a forensic learning disability service." The challenges presented by individuals with learning disability and offending behaviour are not specific to Ireland or to this period in history. The purpose of the present paper is to explore issues related to learning disability and offending behaviour in 19th- and early 20th-century Ireland. More specifically, this paper presents original, previously unpublished case material from the archival medical records of the Central Mental Hospital, Dublin in order to illustrate specific aspects of the institutional experience of individuals with learning disability who were charged with offending behaviour in nineteenth-century Ireland. The Central Mental Hospital, Dublin was established as the Central Criminal Lunatic Asylum in 1845 under the provisions of the Lunatics Asylums (Ireland) Act (1845). Individuals were to be committed to the Central Criminal Lunatic Asylum if they were declared 'guilty but insane' at time of trial or offence, or if they developed mental illness and became difficult to manage while in detention elsewhere. The Central Criminal Lunatic Asylum opened its doors to admissions in 1850 and by 1853 there were 69 male and 40 female inpatients.

The Mental Treatment Act 1945 in Ireland: an historical enquiry

The Mental Treatment Act 1945 had a decisive influence on the provision and development of psychiatric services in Ireland. This paper examines: (a) the historical and psychiatric backgrounds to the introduction of the Mental Treatment Act 1945; (b) the main provisions of the Act; and (c) the international context of the Act, especially in relation to institutional and legislative trends in other jurisdictions.

One hundred years ago: The Richmond Asylum, Dublin in 1907

The Richmond Asylum (St Brendan's Hospital) in Grangegorman, Dublin was established in 1815 to help address the unmet needs of the mentally ill in 19th century Ireland. This paper examines the Richmond Asylum Joint Committee Minutes from 1907 in order to explore specific aspects of management and clinical activity at the Richmond Asylum, including: (a) patient populations in the asylums; (b) staffing and management issues; (c) challenges presented by workhouse populations in the early 20th century; and (d) the clinical 'segregation' of patients performed by the Medical Superintendent, Dr Conolly Norman, in 1907.

Dr William Saunders Hallaran and psychiatric practice in nineteenth-century Ireland

BACKGROUND

Dr William Saunders Hallaran wrote the first Irish textbook of psychiatry in 1810.

AIMS

To explore the relevance of Dr Hallaran's textbook: An Enquiry into the Causes producing the Extraordinary Addition to the Number of Insane together with Extended Observations on the Cure of Insanity with Hints as to the Better Management of Public Asylums for Insane Persons.

METHODS

This paper uses Dr Hallaran's textbook to explore dominant themes in nineteenth-century psychiatry.

RESULTS

Dr Hallaran's approach was characterized by (a) recognition of organic factors in aetiology; (b) concern about apparent increases in mental illness; (c) systematic engagement with causes, courses, outcomes; (d) reconsideration of traditional treatments (venesection, emetics, purgatives); (e) exploration of novel approaches (Dr Cox's Circulating Swing); and (f) re-evaluation of traditional remedies (digitalis, opium, camphor, mercury) and physical treatments (shower baths, diet, exercise).

CONCLUSIONS

Many aspects of Dr Hallaran's progressive approach to psychiatric care remain relevant today.

Murder, mercury, mental illness: infanticide in nineteenth-century Ireland

BACKGROUND

Infanticide has been described in almost every human society.

AIMS

To present a case of infanticide from nineteenth-century Ireland and explore related diagnostic, therapeutic and judicial issues.

METHODS

This paper uses original archival material from the Central Mental Hospital, Dublin to present a case of infanticide and inform an exploration of related issues.

RESULTS

In 1892, 'Dora', a thirty-four year old servant from Dublin, was found guilty of the murder of her eight-month old child and sentenced to indefinite detention at the Central Mental Hospital, Ireland's only inpatient forensic psychiatry facility. The subsequent experiences of Dora ("a case of melancholia") illustrate many of the diagnostic, therapeutic and judicial issues surrounding infanticide in nineteenth-century Ireland.

CONCLUSIONS

There were strong links between social circumstances and infanticide in nineteenth-century Ireland, compounded by myriad diagnostic and therapeutic challenges associated with forensic psychiatric committal and lengthy detention in poorly-therapeutic facilities .