SOCIAL HISTORY:A collection of historical studies reveals that high rates of confinement, appalling conditions  and a lack of amenities were all features of our asylums in the 19th and 20th centuries

Asylums, Mental Health and the Irish 1800-2010, Edited by Pauline M Prior, Irish Academic Press, 352pp, €45

In November 1958, the year the number of patients in psychiatric hospitals reached a peak of more than 21,000, Dr Bart Ramsey, assistant inspector of mental hospitals, reported to the Department of Health on his recent visit to Clonmel District Mental Hospital, which at that time contained 850 patients. He wrote that “every feature and every activity of this hospital is at an incredibly low level”; that “the amenities for the nurses are extremely bad”, with the staff “very near the explosion stage”; and that the stench in the dormitories was “overpowering”.

He also noted that the patients were put to bed at 6.30pm each evening, “largely due to antiquated ideas about security”, and that the “patients undress in day-rooms downstairs” and, as they made their way to the dormitories on the first and second floors, had “no clothing on them except their day shirts and in several cases they are naked”.

Responding to the report, JJ Darby, at the Department of Health, stated that the patients were being kept at a “low level of animal existence” and that “while the position in Clonmel is very bad it is, unfortunately, not unique and there are other hospitals, or parts of hospitals, where conditions are similar to those in Clonmel”.

More than 20 years later, in an in-depth review of psychiatric hospitals in Magill magazine, the journalist Helen Connolly wrote that of more than 14,000 inmates nationwide, most lived “in conditions of squalor and dilapidation utterly inadequate for their therapeutic needs”. Connolly went on that the majority were “outcasts from society”.

As these institutions gradually disappear and their long-term populations die out, Asylums, Mental Health and the Irish 1800-2010 is a welcome response to a growing interest in the role and function of these extraordinary repositories of human misery.

District and auxiliary mental hospitals (or lunatic asylums, as they were originally known) were established in Ireland in the early 19th century. By mid-century, 10 such institutions were open, containing 3,000 inmates, figures that grew to 22 and 16,000 by the end of the century.

This rapid growth can be seen in microcosm in the case of Connaught Asylum, in Ballinasloe, Co Galway. Built in 1833 to accommodate 150 people, by the mid-19th century it contained more than 300 and by the end of the century more than 1,000. By the year of independence, 1922, it was home to 1,482 inmates, despite a restriction in its catchment area that accompanied the opening of Castlebar Asylum, in 1866.

In her chapter on Connaught Asylum, Oonagh Walsh highlights the fact that scandals in mental hospitals have a long history, with Dr William Heise, the first medical appointment to Connaught Asylum, in 1833, resigning in 1848, when it became known that he had impregnated one of the patients and then attempted to conceal the fact by discharging her.

Detained involuntarily

From the mid-1960s the psychiatric-hospital population began to decline, prompted in part by the publication, in 1966, of the report of the commission of inquiry on mental illness, which commented on the very high number of patients detained involuntarily in the following terms: “Statistics in respect of different countries may not be directly comparable, but, even if allowance is made for this, the number of in-patients in Ireland seems to be extremely high – it appears to be the highest in the world. It is hard to explain this.”

Dermot Walsh, in his characteristically informative chapter on mental-health services between 1959 and 2010, notes that in the aftermath of the report, research was undertaken in an attempt to understand this extraordinary use of mental hospitals. This research concluded that whatever the reason might be, it was not that the Irish were particularly prone to lunacy.

Standard explanations for the growth and demise of asylums in other countries have only limited applicability in the Irish case, argues Damien Brennan. He writes that the institutional treatment of mental illness became deeply embedded at the personal and societal level, which resulted in the high rates of confinement.

In her chapter on the Inspectorate in Lunacy, the body that oversaw Irish asylums, from 1845 to 1921, Pauline Prior, the editor of this impressive book, makes a similar point, namely that the high rate of confinement reflected the availability of institutional beds rather than the incidence of mental illness in Ireland.

Not only did the asylums in Ireland contain comparatively high numbers of inmates, but, as Elizabeth Malcolm notes on her chapter on Irish immigrants in Australia and Angela McCarthy in her chapter on New Zealand, in both Australian and New Zealand asylums towards the end of the 19th century the largest ethnic group were Irish-born. This is attributable in part, Malcolm argues, to the facts that Irish migrants to Australia were already familiar with the asylum system in Ireland and that many of the policemen and doctors involved in the committal process were Irish.

Labour history also features in this collection, with Anton McCabe and Ciaran Mulholland’s account of Monaghan Asylum, where on January 29th, 1919, under the tutelage of the republican socialist Peadar O’Donnell, the asylum attendants embarked on strike action and raised the red flag over the building. Their assessment that the strike changed the face of the asylum system forever is somewhat overstated, as evidenced by the report into conditions for attendants and patients alike in Clonmel some 40 years later.

Other chapters in the book focus on particular incidents in the history of psychiatric confinement in Ireland, such as the treatment of tuberculosis in the Central Mental Hospital in the 19th century and the outbreak of what appeared to be beri-beri in the Richmond Asylum (Grangegorman) between 1894 and 1898.

The editor of this volume is careful to note in her introduction that it is “far from being a comprehensive account of the history of Irish mental health services”, and rather provides an introduction to aspects of this history. Ranging from detailed case studies of various aspects of asylum life, including poetry and prose written by patients, and a helpful chronology of mental-health legislation from 1800 to 2010, this edited collection extends our knowledge of the “mad doctors” and the institutions they ran.

A detailed history of these services, particularly for the 20th century, is still to be written. Whoever takes on this task will face a serious impediment in the unavailability of primary archival material on the operation of what Andrew Scull, the foremost historian of lunacy, evocatively described as these “massive mausoleums of madness”.