Abstract
In 1900, 21,000 Irish men and women were being accommodated for under the District Lunatic Asylum system throughout the 32 counties of Ireland: 0.5 per cent of the country’s population were, therefore, receiving some form of psychiatric treatment (p. 51). In 1963, the figures remained high as 19,801 admittances were recorded, but these inpatient numbers drastically declined to 4,256 by 2001 as a consequence of the ‘modernising’ of psychiatric care regimes (p. 193).
Hearing Voices is a work of monumental significance holding national and international relevance in the field of historical psychiatry. Taking on the role as both clinician and historian, Brendan Kelly affords important insights into the history of psychiatric care. The book is a robust and gripping contribution built on systematic archival research and medical records.
Kelly begins by tracing examples of psychiatric illnesses as far back as 600AD. Many of these are rooted in tales derived from local folklore. Subsequent chapters follow the emergence of psychiatry as a profession in harmony with the emergence of the phenomenon of Irish ‘asylumdom’. The book follows a chronological format throughout, making it easily accessible for the reader as the author excavates the rather slow process of deinstitutionalising such a system. Again, his intertwining the roles of the psychiatrist and the historian aids his efforts to detail the continuously evolving system. His conclusion, however, is that “we must do better” (p. 306).
Whilst Chapter One presents a strong history of psychiatric illnesses in Irish folklore, the growth of asylums during the nineteenth century takes precedence for discussion in Chapter Two. Kelly details the reasoning behind and emergence of a national lunatic asylum system by utilising various case studies to detail the harsh realities those dubbed as ‘lunatic’ or ‘idiot’ were confronted with. He also recognises the significant role played by key individual ‘reformers’ and various highly influential political and medical protagonists. These included Robert Peel, Thomas Spring Rice and James Foulis Duncan. Another interesting aspect to this chapter is the role of gender and how it clearly impacted on admittances. Indeed, menstruation, pregnancy and childbirth were key specific elements relating to female experience of early psychiatric care both in Ireland and beyond.
The latter part of Chapter Two merges smoothly into Chapter Three with Kelly carrying on the work of scholars, such as Catherine Cox and Oonagh Walsh, emphasising the essential connection between the workhouse and the lunatic asylum. This, however, remains a relationship still insufficiently interrogated in extant scholarship in this thematic area.
Kelly provides a good social context throughout with readers discovering how political history in Ireland shaped and influenced the practice of psychiatry. This is especially the case in Chapter Four which details the situation in the Dublin Asylums during the 1916 Easter Rising. Kelly also draws attention to the history of the Richmond War Hospital (1916–1919). Here he illuminates the role of the Irish patriot and psychiatrist Dr Ada English of the Connaught District Lunatic Asylum (now St. Brigid’s Psychiatric Hospital).
Chapter Five is an excellent section and it maps the development of psychiatric diagnosis and the progression of medical treatments via the use of case studies. This part of the book is fascinating, but certainly for the reviewer, distressing. Here readers will learn, for example, about the emergence and practice of Insulin Coma Therapy, Convulsive Therapy and lobotomy procedures.
Chapter Six furnishes a more contemporary discussion on the slow deinstitutionalisation of Ireland’s mental health system. Here, Kelly also recognises the difficulty in giving a ‘voice’ to the actual patient within ‘asylumdom’ scholarship and consequently he highlights the plight of the remarkable Hanna Greally. She was a patient of St. Loman’s Psychiatric Hospital who went on to publish her own account of her experiences in the book Birds’ Nest Soup. It is also in this chapter that Kelly delivers a compelling account of psychiatry and homosexuality.
In the final two chapters Kelly, the clinician, is more to the fore. Chapter Seven considers the influences bringing about change with more modern legislation being enacted to encourage community-based living. Chapter Eight provides an analysis of the potential future of Ireland’s mental health system by focussing on statistical trends in suicide in recent decades.
Kelly tells us he has written the book to make a “contribution” to the process of “historical exploration” in respect of his chosen theme (p. 299). However, the topic of mental health is also situated prominently within social policy discourses in Ireland today and this is partly why Hearing Voices is a truly fascinating read.