There is a growing interest in the history of mental health care in Ireland and internationally. Some of the present day interest is influenced by the growing rise of mental health illness throughout the globe as well as the accessibility of archival information on mental health. One of the leading supporters of the history of mental health care is the UK based Wellcome Centre who are active in their support and public sharing of research and exhibitions in relation to the history of mental healthcare. One collection focuses on the infamous Bedlam: the asylum and beyond which covered the history of the notorious Bedlum asylum, also known as Bethlam Royal Hospital which was Europe’s first and oldest institutions to specialise in mental illness.
In Ireland, the poet and satirist Jonathan Swift was influential in setting up the first institution to care for the mentally ill in Ireland in 1746. St Patrick’s was also one of the earliest asylums in the world and its establishment lead to other Irish asylums with the first public institution Richmond Lunatic Asylum in Grangegorman, Dublin (presently known as St Brendan’s Hospital) opening in the early 1800s.
Ireland developed an extensive network of asylums in ratio to its population, percentage wise significantly more than in the UK. Both the UK and Ireland have a rich archival source of records in relation to the history of mental healthcare. However, the UK has fostered a more open door policy to sharing the history of mental healthcare than Ireland. In the UK, there is a growing availability of psychiatric hospital archival records with some sources being digitised and shared online. In Ireland, gaining access to the information is more difficult with no plans to digitise the archival asylum records. Its rich history has been relatively untold and hidden behind closed doors with the exception of a few pioneering researchers, academics and journalists. One journalist who drew significant public attention to the subject was the journalist Mary Raftery, who exposed the Irish psychiatric hospitals as “huge monuments to insanity” in her two part RTE documentary, Behind The Walls. Working with some of the leading experts of the field in Ireland, she delivered a powerful insight into the history of mental healthcare in Ireland.
Clearly, one of the most influential works in the field continues to be Mark Finnane. Finnane, an Irish historian, was one of the early researchers to turn his attention to the growing asylum admissions in Ireland during the late 1800s to early 1900s. Finnane (1981), in his book, Insanity and the Insane in Post-Famine Ireland, justifies that both the birth and growth of the asylum system in Ireland is closely connected and interrelated to the changes in the Irish political, economic and social environment. He also notes that by the early 1900s, workhouses were on the decline as an institute for the Irish poor. Instead he posits, admission to another institute, the asylum, had become a familiar trait of Irish society and a route for the removal of undesirables from Irish society. He argued that the route to confinement in asylums was more about families and communities’ inability to cope with difficult behaviours, than a form of social control. Other historians such as David Wright (1997) supported Finnane’s view and compellingly argued that social conditions, poverty and tolerance had a stronger influence on what was viewed as insanity and the admissions procedure than medical expertise and authority of the asylums. However, unlike Finnane, Wright argues that admission to asylums was a method social control which worked by dividing families’ and society’s pauper social deviants and unwanted into sub-populations whilst inherently confining the lunatic poor to a newly developing psychiatric profession. Wright (1997) also suggests that asylum systems were the progeny of urbanisation and provided a legitimate removal ground for those who could not contribute to the newly developed industrial domain. Authors, such as Greta Jones and Elizabeth Malcolm in Medicine, Disease and the State of Ireland 1650-1940 (1998), contradicted Wrigth’s theories, as Ireland experienced little industrialisation except for Belfast and had a decreasing population due to emigration in the post-famine era which continued well into the twentieth century. Irish scholar, Damien Brennan (2014) suggests that while the urbanisation theory might fit the situation in England and elsewhere in Europe, it would not seem to apply to Ireland in the nineteenth and early twentieth centuries, which was still predominantly an agrarian and rural society.
The strong agricultural demographics of Ireland was in contrast with the increasing urbanisation and population of Britain which is the focus of Wrights study (1997). Ireland was experiencing a steady decline since the mid-1800s. Despite the declining population, Ireland’s admissions to asylums was increasing at an alarming rate, and continued throughout the late 1800s up to the mid-1950s. In Damien Brennan’s Irish Insanity:1800-200 (2014) publication, he analyses the rising admission trends in Ireland in comparison to international figures and using basic data visualisations of tables and figures, he evaluates different models and theories concerning the underlying patterns that he uncovers. Brennan argues that the committal process resulted from a multi layered social process and not one isolated cause, citing the both an increase in mental illness, a decrease in tolerance of the mentally ill in the community and an expanding classification diagnosis system. He examines the socio-demographic features and evaluates their contribution to the establishment expansion and highlights that classification may be an issue. Brennan (2014:28) points out that the diagnosis of insanity or socio-demographic factors in relation to asylum admission have changed over time and are historically inconsistent internationally. Moreover, in England, in the late 1800s they had a different classification system to Ireland where they concentrated more on the classification of poverty in relation to mental health whilst Ireland classified it relation to diagnosis, care and cure. Notwithstanding classification, by 1955, Ireland had more asylum beds and people in mental hospitals than anywhere else in the world (2014:33) with 710.34 asylum beds per 100,000 of population. Within the Irish system, Brennan provides useful observations on the gender and institutional difference over the two centuries, notably the initial higher numbers of female residents in the early 1800s, then an equilibrium of both male and female up until 1890 and then a higher trend of males up to the mid-1950s. He argues that the figures hide the complexity of institutional care of the genders and that if broken down into gender and the type of institutional care for the insane, that there are discrepancies. Whilst there is an overall higher representation of male asylum patients, females outnumber males in sections of the workhouses designated for the insane, and males greatly outnumbered females in the Central Asylum for the Criminally Insane in Dublin. While Brennan’s work is an invaluable illustration of Ireland’s asylum admissions, as well as theories on socio-demographic factors such as regional and occupational of patient committal, there is no specific mention of the Killarney asylum. Furthermore, considering the extremely broad date range, a sizeable proportion concerns itself with the nineteenth-century and the mid to late twentieth century, which is outside the research area for this research. Despite this, Brennan’s work gives a useful backdrop to the socio-demographic profile of patients in the early twentieth century.
Both Finnane (1981) and Wrights’ (1997) research also give a useful background to the socio-demographics of patients as well as a broad evaluation of the criterion of asylum committals. Wrights’ research (1997) on Getting Out of the Asylum: Understanding the Confinement of the Insane in the Nineteenth Century gives an insight into the social history of the asylum interface between the family and the context of committal to the asylum and gives a comparative groundwork and theories on admissions outside Ireland. Though his work is predominately based on the British experience of asylums and is mostly based on the late 1800s, it still has a transferable relevance to the research of this dissertation. Wright utilises archival asylum records for his focus on the socio-demographic diversity and patterns of patient admissions in nineteenth-century asylums and questions the influences on the growing population in British asylums. Some of his later publications add some further perspectives to the socio-demographics of asylum patients. Wrights’ study on Mental Disability in Victorian England: The Earlwood Asylum, 1847-1901 (2001), gives insight to the admission of individuals with congenital mental deficiencies or idiocy, presently referred to as special needs, an area of research that it underdeveloped in Ireland and relevant to asylum admissions in the early 1900s. Another perspective on Wrights’ research is his later collaborative work (Smith et al, 2007) which suggests that the length of time in asylums were influenced by the correlating distance from the asylum. This is of benefit in comprehending the correlation between admissions of patients in the Killarney asylum, the distance from their home union or parish and their length of stay in the asylum.
Finnane, in contrast to Wright, has a strong focus on Irish asylum history and covers both the nineteenth and early twentieth century. Finnane reflects on the background, gender, age, marital and physical health status, family conflicts and variety of behaviours and lifestyles that contributed to asylum admissions. He used statistics from the annual reports of the Inspectors of lunatics to demonstrate trends in admissions and evaluates further utilising a variety of relevant sources including Richmond District Lunatic Asylum casebooks. There are only sparse referrals to the Killarney asylum such as when he emphasises the higher incident of chronic illness in asylum admissions amongst women and patients from poorer rural counties such as Kerry (1981:137) and a chart which indicates that the KDLA had third highest rate of increase in admissions in Ireland from 1871 to 1911 (Finnane, 1981: 135). Though a pioneering source of asylum history in Ireland, Finnane’s account lacks depth that has been found with later literature of Brennan (2014), Kelly (2016) and Cox (2012). Nevertheless, in historiographical context, it is a pioneering book on the history of Irish asylums.
Brennan, Finnane, Cox, Kelly, Prior and other experts in the field of Irish asylum history all utilise a parliamentary paper available from the National Archives of Ireland (2017) called the Irish Inspector of Lunatics report. It is an annual documentation, and comprehensive evaluation of data that has previously been collected and tabulated from district asylum administration sources throughout Ireland, since 1846. It is an essential reporting system on the history of Irish asylums, admissions and population in the early twentieth century. The reports were submitted yearly to the Lords Lieutenants and Governors General of Ireland and after 1921 to the Minister of Health. Of specific interest is the collection of data on the asylum population and socio-demographics of residents over the early twentieth century. The reports give a valuable break down on each individual asylum, including the KDLA and a concise description of their observations when they visited. Additionally, the numbers of residents, and statistics on patients who were admitted, discharged, died, and escaped from the asylums are also logged. Primarily a descriptive and evaluative perspective on the conditions and residents of national asylum system, it is regarded as the first reporting system in the mental health services of this country. As a primary data source, it is a valuable, if sometimes biased, foundation for comprehending the socio-demographic profile of the asylum population (Williamson, 1970).
Catherine Cox in her book (2012) Negotiating insanity in the Southeast of Ireland: 1820-1900 approaches the history of the asylum through the lens of Carlow and Enniscorthy district asylums. Utilising both the Inspector reports and asylum archives, Cox gives a comprehensive evaluation of the socio-demographic profile of patients admitted to Carlow and asylums. Cox continues to challenge the social, familial and administrative contexts of admissions as well as exploring the susceptibilities of confinement (2012: 138). In her chapter, Households and Institutions, she contests mental health expert, Dermot Walsh’s (Cox 2012:139) viewpoint that the high number of admissions among single, relatively young men was cause by the inheritance issues especially among families with substantial farm holdings and high rate of male celibacy in post famine Ireland. Both in Carlow (Cox, 2012:139) and in Killarney (The National Archives, 2017), families with substantial farm holding were a marginal section of the rural community as the majority of the population were small tenant farmers. While Cox agrees that society became less tolerant of forms of male violence in the late nineteenth century, she suggests that single men were more vulnerable to committal regardless of inheritance conflicts, celibacy and violence, reflecting a national and international trend. Coxs’ descriptive analysis of such demographic and social variables is relevant for this study even while taking into account that, at time it is susceptible to simple conclusions rather than statistical validations.
Another aspect of Coxs’ analysis which is of interest to this study is her perspective on the health of the patients entering the asylum. Cox (2012) suggests that the famine had a profound effect on the rising mental health issues of the predominately rural Irish dwellers and noted that many were suffering malnourishment, living below poverty levels on limited agricultural production. Physical health problems were a common factor in mental asylums with condition such as thyroid, general paralysis of the insane (neuro-syphilis), Phthisis (tuberculosis) and malnourishment being recorded as contributing factors prior to admission to mental asylums. Though Coxs’ book has no reference to the Killarney asylum and its focus is on the nineteenth century, it is an invaluable literature covering the context of a provincial town asylum and the socio-demographic profile and associated underpinning theories.
Dermot Walsh is another renowned expert on mental health care in Ireland who is concerned with the socio-demographics characteristics of the Irish asylum patient. Like Cox, he acknowledges the rise in the incidence of mental illnesses diagnosis, in post famine Ireland (Walsh, 2012). However, Walsh maintains that the findings may not specifically be related to the famine as similar admission increases were evident in other jurisdictions over the same period. Nevertheless, Walsh, in his paper Did the Great Irish Famine increase schizophrenia? (2012) does suggests that the severe nutritional deprivation between 1845 and 1850 may have caused epigenetic change which consequently could have predisposed survivors of the Great Famine to mental and physical health problems. Walsh has published numerous academic papers and books on Irish asylum history. His collaborative papers with Antionette Daly and commission for the Health Research Board (Walsh & Daly, 2004) are of interest for this study primarily for their section on The Consolidation of Confinement – 1900-1960. Similar to other studies (Brennan 2014 ), Walsh & Daly, discuss the rapid growth in asylum residents from the mid eighteenth century to the first half of the twentieth century, noting that by 1914 there were 16,941 persons resident in the public asylums of the 26 counties. This contrasted with resident numbers during the First World War which had dropped to 15,714, in 1918. In a different research Walsh & Daly (2002:84) emphasise some of the characteristics of the patients, noting that 11% of asylum population were primarily intellectually disabled often referred at very young ages.
Steven Cherry (2003), in his work on the Norfolk Lunatic Asylum, suggest the importance of context and locality for understanding the historical changes in asylum system. Cherry (2003:6) suggests that there are different perceptions of insanity, which have changed radically over time. Cherry advocates that case notes and individual case histories are an extensive resource in the reconstruction of the patient experience and a glimpse into the perceptions of insanity in that era. He focuses expansively on admission registers and patient casebooks to document the practices of the people whose lives were interconnected with the asylum, the patients, their families and asylum staff. He proposes that the documentation of insanity allows for a method of surveillance that provides unparalleled resources for a social history of asylums (Cherry 2003:6) and emphases the value “history from below” especially in its potential to describe the patient’s stories (Cherry, 2003:44). One theme that Cherry refers to is the proportion of suicidal patients admitted annually to public asylums. Cherry’s work on the Mental Health Care in Modern England: The Norfolk Lunatic Asylum/St Andrew’s Hospital, 1810-1998 has minimal reference to the Irish history of the asylums but importantly, captures a perceptive on the potential of asylum archival research which is thought provoking and transferable to this research.
Pauline Prior also approaches the subject of suicide in her book Madness and Murder: Gender, Crime and Mental Disorder in Nineteenth Century Ireland. Her writings are greatly influenced by the Central Criminal Lunatic Asylum in Dundrum, Co Dublin and she utilises archival asylum records and the Inspector of Lunatics report to discuss the different societal perceptive son crimes committed by male or female asylum patients. She also approaches an under-reported patient demographic; the returning emigrant or assisted returning emigrant who is admitted to the asylum. Prior has edited a 2012 collection of essays on Asylums, Mental Health Care and the Irish: 1800-2010 where she contributes an essay on Overseeing the Asylums: The Inspectorate in Lunacy, 1845-1921. Prior analyses the contribution of the Inspector of Lunatics report, its limitation, the rising insanity rates, socio-demographic and other trends. Though much has already been covered with the previous literature, Priors’ has demonstrated the ability to concisely articulate and scholarly evaluate the key points related to the 1900s.
Overall, there has been minimal literature sources or even references to the Killarney asylum, St. Finan’s, in the main historical research. Brendan Kelly (2014:134) in his excellent book Hearing Voices: The History of Psychiatry in Ireland describes the only significant coverage related to a case study of a County Kerry family experiencing a folie à deux in 1888 which gives a comprehensive description and evaluation of a shared psychosis experienced by a family from Beaufort, Co Kerry. Apparently, numerous members of the Co Kerry family experienced a bout of insanity at the same time. This included three daughters, a son, and both parents. During the psychosis, they had killed one of the children, a boy with learning difficulties, believing the child to be a changeling. According to the Irish Times of 1888, they family was found by the local constabulary in a demonic manner, their bodies in a state of undress and threatening all who approached the house armed with scythes, reaping hooks and pikes. Though an interesting and rare description of mental illness in County Kerry, Kelly does not refer to any other significant aspects of mental healthcare in St Finan’s in his historical findings.
There is one local history book by Dermot Dwyer (2002) St Finan’s Hospital, Killarney: A Medical, Social & Sporting History 1852-2002 which gives an interesting report on the staff, staff activities and sports. It is accompanied by an introduction to the history of St Finan’s Hospital, as well as some short fictionized stories of the patients. However, the book has no socio-demographic profiling of the patients and there are limited details or evaluations of the lives of the patients in St Finans.
Finnanes’ histographical portrayal of the Irish asylum system as well as the archival data and perspectives of the Inspector of Lunatic reports give a good grounding to this study. Theoretical perspectives on the patient, admission and population growth from experts such as Brennan, Cox, Prior, Kelly, Wright, Walsh succinctly add to the contextual portrayal of the patient socio-demographics. Cherry enforces the unique benefits and opportunities of capturing knowledge from the primary archival source, and this study (website) emphasizes the role of digital humanities in enabling new perspectives and audiences to emerge from the process. Significantly, the lack of credible literature on the Killarney asylum highlights a major gap in knowledge which will be the long-term aim of this work.
Brennan, D, (2014). Irish Insanity: 1800–2000, 1st ed. Routledge, London.
Cherry S (2003) Mental Health Care in Modern England: the Norfolk Lunatic Asylum/St. Andrew’s Hospital c.1810–1998. Woodbridge, Suffolk: Boydell Press
Cox, C (2012). Negotiating insanity in the Southeast of Ireland. Manchester University Press. Manchester
Dwyer D (2002) St Finan’s Hospital, Killarney: A Medical, Social & Sporting History 1852-2002. Killarney Printing
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Prior P (2008) Madness and Murder: Gender, Crime and Mental Disorder in Nineteenth Century Ireland. Irish Academic Press
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Walsh O (2015) Insanity, Power and Politics in Nineteenth-Century Ireland: The Connaught District Lunatic Asylum. MUP London: Manchester University Press