An open secret: Ireland’s lunatic asylums and mental hospitals

"Lunatic asylums. Mental hospitals. Psychiatric hospitals." The language associated with mental health in Ireland has changed over the decades, and continues to change.

More than two dozen “lunatic asylums” were built throughout Ireland in the 1800s. They were often enormous structures, and constructed to endure. There is probably still one of these original buildings in the county you live in, though now it will carry another name.

St Otteran's Hospital in Waterford was formerly the Waterford Lunatic Asylum. St Loman's Hospital in Mullingar was the Mullingar Lunatic Asylum. St Canice's Hospital in Kilkenny was the Kilkenny Lunatic Asylum. There were many others, and their population remained consistently high throughout the decades.

In 1951, the town of Ballinasloe in Co Galway had a population of 5,596. There were 2,078 resident patients in the town's St Brigid's Hospital, formerly Connaught Lunatic Asylum. In 1956, as recorded in Brendan Kelly's book Hearing Voices: The History of Psychiatry in Ireland,  20,063 people were in public mental health hospitals.

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Unlike those other Irish institutions behind walls  that housed vulnerable people, such as mother and baby homes and industrial schools, asylums for the mentally ill were never run by religious orders. They were State-run and funded, usually at a local level. This also meant that, unlike the autonomously run religious orders, they were regularly inspected. In addition, they employed a great number of local people who worked there daily. For instance, many asylums had large farms and vegetable gardens. They were integrated into wider Irish society in a way that the more secretive religious-run institutions were not.

Ennis Lunatic Asylum in Co Clare was by far the largest public building in the county when it was constructed in 1868. It had a grand Italian-style palazzo at its centre. To my knowledge, its ever-more derelict presence on the outskirts of the town on the Gort Road continues to hold that record, more than 150 years later. The building cost £54,000, and was on a site of 52 acres. Its name changed over time to Ennis Mental Hospital and, by the time it closed in 2002, Our Lady’s Hospital. Full capacity was 600, although it was frequently overcrowded.

The resident medical superintendent: ‘The asylums were a creation of the society they existed in’

Kieran Power, now retired and who lives in Co Galway, has had a unique insight into how these former mental hospitals in Ireland were run. Every mental hospital was headed up by a resident medical superintendent (RMS). The RMS was the key job within the asylum. He (they were always male) had responsibility for all aspects of the hospital's administration, including patient admission, care, discharge.

Power's father, Patrick Power, spent most of his working life in these hospitals. Kieran was born when his father was working in St Columba's Hospital, formerly the Sligo Lunatic Asylum. In 1957, when Kieran was six, the family moved to Ennis, where Patrick Power was the RMS until 1982. Power himself went on to work in the same area of psychiatry, and later held the role of clinical director in Ballinasloe from 1989 to 2009. In all, he either worked or spent time in five mental hospitals around the country.

“I have spent all my life in mental hospitals,” as he puts it.

As a child growing up living in the RMS’s quarters at the centre of the hospital, he recalls the family’s integration with the patients. “We mixed with them; there were no restrictions on us meeting patients. In fact, we had a patient who used to come up and do housework. She became one of the family and used to go away with us on holiday. She died in 1971, but she was very close to us.”

At the time this woman died, she had been a resident for some 30 years. “She was there because of family,” Power says. “They admitted her. She was in for, as a lot of the older people were, the longer stay; a lot of them came in for what would nowadays be regarded as anxiety and depressive states. And then they sometimes contracted TB. They got it in the hospital. TB was a major problem in all these places.

“This woman would come up and cook our meals. She got paid by my dad. She would babysit us at night if they were out, and that’s where we learned how to play cards. She taught me how to play 25.”

I ask if it was true that patients got TB in hospital in the 1950s.

“It was true in the 1990s,” he says. “I was clinical director in Ballinasloe for 20 years, and in 1991 we had to get a portable TB X-ray machine because, by then, they had disposed of all the walk-in mobile TB vans. We had an outbreak in 1990 in Ballinasloe and I remember we had to get a portable X-ray machine, lead-line the room, employ a radiologist and a radiographer, set up an isolation unit and treat patients.”

He tells me about a male patient he encountered in Ballinasloe who was typical of patients of all five hospitals he lived and worked in over his lifetime.

"He called himself the [Lord of Ballinasloe]. He had a delusion that he was the [Lord of Ballinasloe] and he used to go to the bank in town and they would give him old pennies and he'd walk through farmyards dispensing the pennies to the labourers. They humoured him. Now, if that man was living in Ennis town or Kilrush, or Ballinasloe or any small rural town, he wouldn't have been tolerated. He would have been ridiculed. In the hospital, he was able to live as free a life as was possible. All the hospitals were full of characters like that. These places were called asylums for a reason."

When people were admitted, they were sometimes living in better conditions than they would have been at home

It’s fair to say that most people today would now consider the existence of these former asylums to have been aberrations. What is Power’s response to this?

“I suppose like institutions of any descriptions, they were a creation of the society they existed in. We also have a whole generation of people now who didn’t know what these places were,” he says. “One of my problems with the sociologists was, and still is, their spin, if you like, on these places: that very often people were being detained at the pleasure of the medical staff.”

He points out that, contrary to popular misconception, medical staff never sought out patients.

“When people were admitted, they were sometimes living in better conditions than they would have been at home. If you go back to the 1920s and 1930s, this is certainly true of parts of Clare and rural Ireland generally. And they were in places that were much better regulated. There were regular inspections of the hospitals.”

Why was it that so many people were long-term residents?

“It very often didn’t suit families to take them home again. You had the shame; you had the stigma when people had been residents. Families also often wanted people out of the way because of ownership of land. This was a constant thing, even up to the end of my time. Families who would have had another generation of sons in the meantime, did not want those long-term residents home.

“A lot of people who were hospitalised would have had rights of way to family properties. When the occupants at home wanted to give a site, for instance, to another member of the family, a son or daughter, they would have to get rid of the right of way for the person who was in the hospital. We frequently had families coming in and taking relatives out and having them sign documents unbeknown to us.”

Did this happen in his time?

“Oh yes, that was happening in Ennis, and so it was certainly happening everywhere else. I recall it very vividly in the 1990s.”

Power says it was common practice for some residents to leave the hospital during the summer, to go and work on farms. They came back again for the winter. Sometimes they worked for relatives and sometimes for people who wanted labourers.

“I know from my own experience in Ballinasloe that there were people who would go out for the summer to help the farmer cutting turf. They were nearly fostered by particular farmers.”

I ask if their families knew this was happening.

“Some of them didn’t even have families that were engaged with them,” Power says. “They got paid for their work, and they got their board and keep. They would stay out for the summer, and they came back in again in the winter. They were the knights of the roads.”

The smell of urine was indigenous in the place. At this stage we were literally papering over cracks. You could buy a modern bed, but that bed was still in a 150-year-old building

By the time Power was clinical director in Ballinasloe in 1989, he was working in a building that had been constructed in 1833; an astonishing 150 years earlier.

“I remember public representatives writing to me complaining that their constituency members had reported the smell of urine on a long-stay ward. The problem is that a lot of these public representatives didn’t actually come in to visit the hospital and see for themselves. I remember writing that to a minister at the time, explaining that the building had been there since the 1830s, and that the smell of urine was indigenous in the place.

“At this stage we were literally papering over cracks. You could buy a modern bed, but that bed was still in a 150-year-old building.

Assistant chief nursing officer: ‘Asylum is a good word; it’s a refuge’

Eddie Lough, who lives in Ennis, was a former assistant chief nursing officer at Our Lady's. He worked there from 1967 until its closure in 2002, and was in his 20s when he went to work there first. We meet in a cafe in Ennis.

“As youngsters, we cycled very fast past the high walls of the mental hospital. It wasn’t Our Lady’s then,” he says. “It was the asylum to us. It was a place to be feared, and the people who were in there were to be feared. People didn’t know what went on there. It was as if the place was invisible. I really believe it was invisible to those who didn’t have anything particular to do with it, or have any relatives in there. People didn’t want to know about it.”

Lough went to work there in his 20s. “To be honest, in the 1960s, there wasn’t a hell of a difference between the 19th century and the 20th century. It was horrible. Unbelievable. A lot of people had been there for 20, 30, 40 years.”

Over time, Lough says he changed his perspective. “Asylum is a good word; it’s a refuge. People now, unless they understand history, when they are talking about what happened in those places, they are looking at it through modern eyes. You have to go into the time machine and go back. People were sent in there for various reasons.

“Many people had no place else to go, and their families didn’t want them back. People today think there were no discharges, but even back in the 19th century, residents were discharged if they had someplace to do, or had some relative to go to.

“The other thing that people forget today is that the asylum or hospital never sent for anyone. Blaming the asylum as an institution and the staff isn’t right. It was society that sent people in there, and society that kept them there in a way, because either there was no place for them to go or their family didn’t want them. Now, there were definitely people in there who were disturbed and who were a danger to themselves, but that goes without saying. You could say the same for today’s mental health services.”

Before Our Lady’s closed 20 years ago, Eddie Lough took it upon himself to salvage its extensive paper archives. These were strewn haphazardly through the vast and damp basement and, without his far-sighted intervention, much of the hospital’s archive would undoubtedly have been destined for skips.

“I became aware of the records in about 1995,” he says. “One effort had been made to put admission forms together into cardboard boxes.” That was it. Nothing else had been done to record or preserve these documents.

In his own free time on his days off, Lough began to sort through the papers. He found minute books, ward books, admission and discharge books, committal forms, account books, and many other documents, some going back a century or more. “I managed to get a room cleaned out, and get shelving in it. In about 1998, I put a sign on the door saying “Archive Room”. Once I had done that, the papers couldn’t be dumped.”

The documents, which occupy an entire room, and number in the thousands, have yet to be catalogued

After the hospital closed, an agreement was reached between the then Mid-Western Health Board and Clare County Archives about the records Lough had saved. The documents, which occupy an entire room, and number in the thousands, have yet to be catalogued. They relate only to the former Our Lady's Hospital in Ennis, and many go back to the 19th century.

There is a list of the documents, which took a year to process. Under the procurement agreement, an arrangement was made that determined the majority of the documents would be closed for up to a century. This was due to the sensitive nature of the records, and the fact that many former residents and their family members were still alive.

It is, however, possible to make an application for specific research purposes to view these records, and there are different levels of access.

I made an application for level one access. This grants access to the entire archive. It took some weeks, but the application was eventually granted, on the understanding that none of the information I used in this article could identify any of the people named in the documents.

As the records are not catalogued, and there are so many thousands of them, the best I could do was call in some dozen diverse files by way of pure guess. A proper analysis of the entire archive would take months, if not years. I read the files I had requested over a day and a morning in one of the county archive reading rooms in Ennis.

These are some of the things I found out by looking at the files I randomly requested.

In 1950, there were 77 staff employed at the hospital, at an annual cost of £31,716. Fuel for the year – which was turf, in open fires – and light, cost £11,491. Provisions were £14,786.

A ward book for the male section of the hospital for the first six months of 1969 had specific printed categories to denote the number of residents and their status. There were 380 male residents present on January 1st, 1969. The ward book was filled in every evening. The categories include “Receptions [Admissions], Discharges, Deaths, Escaped.”

There were also records in the ward books of the number of patients employed each day. On that day, 20 were working in the farm and gardens; two under the category of “bakers, tailors, shoemakers”; three under “carpenters, painters, masons”; seven between the “engine house and officers’ quarters: and five in the “dining hall and kitchens”.

Attendances at the on-site chapel were also recorded daily. On that day, 119 males had been to the Catholic church, and zero to the Protestant church.

I read this note: “Patient A got out of bed at 7pm and made an attempt to escape. Went outdoors in his dressing gown. Taken back by nurses.”

In the pages of that ward book for the following days, there are various other accounts of patients attempting to escape.

“Patient B absconded from dining hall at lunch time. Ground searched immediately. Found and taken back.”

“While returning from supper, Patient C and Patient D absconded. Missed immediately. Search of ground and town carried out by nursing staff. Reported to Ennis gardaí.”

One of the files I requested turned out to be reports on 45 patients, both male and female, who were admitted in the early 1960s and prescribed Niacin. At that time, it was being trialled in various mental hospitals in Ireland, and employers there were asked to observe results of the trial, and return their reports to a named doctor in St John of God Hospital in Dublin, whose letter is part of the file.

Any identifying details of patients in this file who were prescribed Niacin as part of their treatment have been edited out. They all came from Co Clare, as did all residents of Our Lady’s Hospital.

Case One

“[Patient E, a young girl] admitted 1964, who lived at home on a farm. She had run away from home and expressed the idea that her father was trying to kill her. At the time of admission, she admitted to feeling persecution, regarding her neighbours and friends, and described visual hallucinations, during which she said she saw ‘a pathway’, long along which she was to travel, that she came to where the path divided in two, and she could choose either right or left pathway and these were for her choosing between right and wrong.”

It was interesting to note in this case that her attack was precipitated by her father having arranged a marriage for her with a man of some 56 years of age. She was altogether against this marriage herself.

This patient received electronic convulsive therapy (ECT), Largactil, and Niacin, and was later discharged. The notes record the marriage was called off.

Case Two

“[Patient F, a young man]. August 1963. He requested that we phone Bishop X, requesting that the bishop proceed to [Patient F’s] hometown in Clare, to take charge of his room. He stated he had been in touch with his parish priest, with Bishop X, the Apostolic Nuncio and the pope about the secrets of Fatima. The secrets of Fatima [according to the patient as recorded] are three in number, 1) disease will disappear from the world 2) the complete unity of all Christian churches will come about 3) the present pope is not the senior pope. Another pope will be elected and this pope will marry and will live on Scattery Island on the Shannon. This pope will be none other than [Patient F] himself.”

Prior to admission, Patient F had lived with his mother and an “invalid” sister. He spent several months in the hospital, receiving ECT, Niacin and “various tranquillisers”. The notes on his case end with the observation that on initial admission, he had been “mad as a hatter”.

Case Three

"[Patient G, a young man]. Shabbily dressed, noted to be of subnormal intelligence... had served two jail sentences for breaking and entering. Had tried to assault his parents… admitted to hospital because he had broken a shop window in X village in Clare without any apparent reason. During his stay in hospital he expressed great admiration for criminals and especially those involved in the Great Train Robbery in England. He said he would like to have been in on that job. Eventually he ran away from hospital. Some time later arrested for housebreaking and sent to prison."

The notes record Patient G had “a long history of schizophrenia, his brother also was a paranoid schizophrenic, and had also been a patient in Ennis, and he also had an uncle who suffered from mental illness.”

Catholic Church: References

Having read all 45 case studies in this 1960s file which I randomly requested, it is striking how frequently patients in that file referenced the Catholic Church in bizarre ways. It’s possibly an indication of the church’s influence in Irish society at that time. These are some of the notes recorded by staff members of these patients who had been admitted.

I am acting for God. I am going to be the next pope

“She said that people had spread false rumours about her, especially to the clergy and for this reason she abused them... She stood outside shops and shouted abuse at people inside.”

“Shows delusions about a daughter of hers being in a convent… prays excessively… talked about having an apparition of the Virgin Mary while she was in church a month ago and a message being conveyed to her about receiving communion.”

“I’ve a special mission in life. I should have been a priest or a brother.”

“I am acting for God. I am going to be the next pope.”

“[Patient H] went on to state he had a mission in this world from God and that he was to save the world. [He said] I am Jesus, do you see him speaking through my lips.” [Patient H] then went into a long rigmarole about himself being the Word. Earlier that day he had gone out into the street semi-nude and set about preaching to those who were passing by. To others in the ward, he said, “I am Jesus, oh you of little faith, get down on your knees.”

“On admission [Patient I] said, ‘I have not been well for two years. I now think people believe I am the Devil. I can hear him in my room at night.”

Patient J was a “regular” patient. “For the last 10 years, he had delusions of a religious nature. For instance, in an extract from a letter he wrote: “I was praying up to the Sacred Heart picture that day and gradually and gently I was forced back against the wall and the upper portion of me felt like Christ crucified and I even saw the head and shoulders on the picture coming to life. It was a miracle.”

Patient K was “praying loudly and singing hymns. He had a large crucifix with red tapes hanging around his neck. Completely preoccupied with religion. Each time he came there was a strong religious content to his delusions. He was in the habit of building altars in the house and going through all the action of saying Mass... during his stays in hospital, he was very preoccupied with religious matters. For instance in church he would kiss the floor before he knelt to pray. On one occasion when it was proposed he should take ECT he stated that Jesus and Mary had spoken to him and had advised him not to have it.”

Patient L “lay in bed, his arms crossed cruciform on his chest. Admitted to visual hallucination of the Blessed Virgin Mary and believed he had seen the Blessed Virgin Mary... and to hearing her speak to him.”

There is much about the asylums that we now rightly regard with horror. Surprise should not be one of them

Over the many decades of their existence, tens of thousands of people in Ireland were resident in either “lunatic asylums” or their successors on the same sites, and in the same buildings, “mental hospitals”.

One thing is certain. These institutions were not places of secrecy, contrary to what people today may believe. They were connected with the societies within which they functioned. Many local people worked there, and went home each evening with their stories.

It is impossible to think that small, tight-knit communities of towns and villages all over Ireland throughout the decades from where these patients came did not know where their neighbours had disappeared to. Or why some of them never came home again. Or know why it sometimes suited families that people in their midst would not return.

It is a fact that our former mental hospitals in Ireland were open secrets, which is an uncomfortable truth to contemplate today. There is much about them that we now rightly regard with horror. Surprise should not be one of them.

If you have a story to share about residents or employees of any former mental hospital in Ireland, please email rboland@irishtimes.com