Mental illness in 19th-century Ireland: A qualitative study of workhouse records

Deinstitutionalisation and the move to community care: comparing the changing dimensions of mental healthcare after 1922 in the Republic of Ireland and England

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care.

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.

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.