Abstract
The past decades have seen a proliferation of studies focusing on mental institutions in their local context, making the subject of Cox’s book a familiar topic to historians of psychiatry (e.g. Cherry, 2003; Foss and Trick, 1989; Gittins, 1998). Painstaking analysis of hospital records has yielded valuable information about the relationship of mental hospitals to their surrounding community, including significant findings about patients’ socio-economic backgrounds. Disentangling the various actors involved in a patient’s admission and discharge, as Cox has attempted, is, however, much more challenging.
Negotiating Insanity in the Southeast of Ireland is a valiant effort to ‘assess how local actors and groups […] altered and negotiated the administrative, legal and cultural structures of local asylums’ (p. xvi), thereby redressing traditional imbalances in the historiography of psychiatry so often overrating the benefits of institutional treatment. Cox is primarily concerned with nineteenth-century Ireland, a previously under-researched geographical location during an era of major psychiatric changes which coincided with significant ideological and social developments. In this book, Cox illustrates that far from being merely instruments of ‘social control’, Irish asylums served a great variety of social needs, their walls being much more permeable than frequently assumed.
This well-written book is divided into eight chapters, offering broad thematic surveys. The structure allows the author to present changes occurring between 1820 and 1900 from the perspective of national, regional and local contexts. After starting by sketching the national legal framework, Cox takes her readers into two Irish asylums – Enniscorthy and Carlow – discussing the demand for them against the backdrop of increasing asylum populations undermining the institutions’ curative functions. She then delineates patients’ journeys into the institution through various certification procedures. Cox further illustrates how institutional patient profiles reflected local culture within the context of nineteenth-century southern Ireland, and she then explores individual household and family situations.
Cox’s meticulously researched monograph is heavily based on administrative records and newspaper extracts, the details of which occasionally make for taxing reading. However, the author makes the book accessible and appealing to an audience beyond academia by interspersing the records with extracts from authentic case studies and a careful examination of the various parties involved in negotiating patients’ admission to (and discharge from) the asylum.
Having said this, there are several disappointing omissions from the book. Firstly, it would have greatly benefited from contextualization, particularly with respect to wider developments and theories in the history of psychiatry. Cox’s lack of engagement with many (non-Irish) case studies and general theories of institutional care not only affects the more general applicability of her case study, but also renders it unsuitable for the more theoretically-inclined reader. The second shortfall of the book concerns the comparatively scant attention given to lay actors, in particular patients’ families, whose often vital role in recognizing mental disorders has been commonly accepted. Cox acknowledges the importance of the family in her conclusion, claiming that ‘the politics of the family and its influence on asylum admissions and discharges is a central theme of this study’ (p. 241). Although her success in shedding light on the negotiations between legal and medical experts is indisputable, readers might feel that she has been much less successful in the integration of lay actors. Families do figure in the routes into the institutions, but while a whole chapter is dedicated to life in the asylum, family interaction is largely absent from this (apart from visitors as potential carriers of diseases; p. 226). Existing scholarship attests to the often profound influence of such contacts on hospital treatment (e.g. Coleborne, 2009; Smith, 2006; Wannell, 2007). It is hard to believe that Ireland was different in this respect, but if it was, this would have been a point to emphasize more. Cox further questions why families chose to send their members to asylums. This is undoubtedly a complex point with many cultural, social and financial implications to be considered. However, the most obvious reason – families’ inability to cope with the distressing signs of their relatives’ illness – hardly surfaces.
Finally, Cox’s approach to her sources is largely qualitative and interpretative, an undeniable advantage over earlier accounts that have been frequently over-reliant on details gathered from admission or discharge registers. In the chapter on ‘Households and Institutions’, however, the book clearly falls well short of delivering on its potential in both topic and data. Here, the author attempts quantitative analyses; she could have used the demographic and social variables available to carry out more complex correlations and regressions, but this chapter represents an opportunity missed. The assertion that age, gender and other demographic characteristics affected hospital admissions and treatment outcomes needs to be validated statistically. Instead, by basing her interpretations on descriptive analyses, Cox allows the results to be extremely susceptible to simplistic conclusions.
In sum, Negotiating Insanity in the Southeast of Ireland provides a window into the relationship between nineteenth-century mental institutions and their surrounding context, and it should heighten awareness of the variety of actors involved in a patient’s journey into (and out of) the institution. This makes it valuable not only to historians of psychiatry, but equally appealing to local and family historians. Its good structure and accessibility also make it suitable for the university classroom.