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respected journal Brain.321

      These cases of the three brothers are particularly interesting in light of indications that they suffered from an acute physical illness with delirium, which accounted for their delusions and other psychiatric symptoms. Their treatment in hospital was described as ‘moral supervision and dietetic’, an approach which involved regular exercise, gainful employment and an emphasis on healthy diet,322 all of which were consistent with the principles of ‘moral management’.323 Other activities the Central Criminal Lunatic Asylum during this period included were ball games, dancing, music, evening parties and reading books and newspapers (although many patients were unable to read).324

      These cases also demonstrate the problems with tuberculosis (‘phthisis’) in the Irish asylums in the late 1800s and early 1900s:325 at least one of the three brothers, Brendan, died of the disease. Interestingly, one of the other brothers, Patrick, contended that their illness was ‘brought on by “something” they all partook of while at meals, but is unable to say what the nature of this “something” was’. This is consistent with evidence from another case of folie à plusieurs described by the remarkable Dr Oscar T. Woods, medical superintendent of the Killarney Asylum, in 1889 and, later, president of the MPA,326 in which bad food was also seen as a contributory cause.327

      Overall, the cases of the three brothers demonstrate many of the challenges that ‘communicated insanity’ presented to mental health and judicial services in nineteenth-century Ireland and which remain relevant in the 2000s. Over a century after these cases, the optimal balance between punishment and treatment still continues to be difficult to achieve in contemporary mental health services,328 and both treatment329 and community reintegration present ongoing challenges, especially in cases with substantial forensic dimensions.

      Women and Mental Illness in

      Nineteenth-Century Ireland

      Women with mental disorder were treated differently than men throughout the nineteenth and twentieth centuries by the Irish criminal justice and psychiatric systems.330 Following committal to the Central Criminal Lunatic Asylum in Dundrum, for example, women generally experienced shorter periods of detention and were more likely to be discharged than men.331 This might be attributable to the nature of offences committed by women: 54 per cent of women detained at the Central Criminal Lunatic Asylum between 1868 and 1908 (a total of 70) were charged with or convicted of killing, of which a majority (70 per cent) involved child killing.332

      Issues related to menstruation, pregnancy and childbirth were significant factors in determining how these women were viewed in many jurisdictions, including Ireland.333 Parry writes that Hallaran’s ‘emphasis [in 1810] on childbirth and menopause as factors which led to insanity in women was the beginning of what would become medical orthodoxy – the link between female biology and insanity. The work of Thomas More Madden, at the end of the century, shows how this opinion of the causes of insanity had gained wide acceptance. Madden, who was physician to St Joseph’s Hospital, Dublin, argued forcefully that insanity in women was caused by their reproductive capacity’.334

      In a similar vein, Dr Fleetwood Churchill wrote, in the Dublin Quarterly Journal of Medical Science in 1850, that cyclic changes in bodily health affected women more than men, with consequent effects on mental activities, and that menstruation, conception, pregnancy and childbirth could all produce disturbances which could amount to insanity.335 In Great Britain, Dr Henry Maudsley (1835–1918) agreed, pinpointing irregularities of menstruation as known causes of mental disorder which could generate suicidal or homicidal impulses.336

      Similar emphasis was placed on menstruation as a cause of mental disorder or disturbed behaviour in the US.337 In 1865, one female defendant was found insane at the time of a particular shooting owing to apparent insanity resulting from a combination of romantic problems and dysmenorrhea.338 Dr Isaac Ray (1807–1881), founding father of forensic psychiatry in the US, in his Treatise on the Medical Jurisprudence of Insanity, described an apparent association between menstruation and fire setting, citing several cases ‘in which the incendiary propensity was excited by disordered menstruation, accompanied in some of them by other pathological conditions’.339

      One particular case involved a 22-year-old woman who ‘committed three incendiary acts’ but ‘had had a disease two years before, that was accompanied by violent pains in the head, disordered circulation, insensibility, and epileptic fits; and that since then menstruation had ceased’:

      That the evolution of the sexual functions is very often attended by more or less constitutional disturbance, especially in the female sex, is now a well-established psychological truth […]. Any irregularity whatsoever of the menstrual discharge, is a fact of the greatest importance in determining the mental condition of incendiary girls.

      Ray also described a link between ‘the propensity to steal’ and ‘certain physiological changes’ in women, including pregnancy. He outlined the case of one ‘pregnant woman who, otherwise perfectly honest and respectable, suddenly conceived a violent longing for some apples from a particular orchard … and was detected by the owner in the act of stealing apples’. The woman was ‘convicted of theft’ but a ‘medical commission was appointed’ to review the matter:

      Their enquiries resulted in the opinion that she was not morally free, and consequently not legally responsible while under the influence of those desires peculiar to pregnancy; adding that if Eve had been in the condition of the accused, when she plucked the forbidden fruit from the tree, the curse of original sin would never have fallen on the race.

      Medical and judicial views on menstruation, pregnancy and childbirth were to remain highly relevant to issues of criminal responsibility in women throughout the remainder of the nineteenth century, especially in relation to infanticide. This emphasis was not, however, limited to the field of forensic psychiatry. Parry notes that the very idea of ‘moral insanity’ had particular implications for women in the Irish asylum system:

      The concept of moral insanity, in essence denotes the re-conceptualisation of madness as deviance from socially-accepted behaviour, that is to say, traditional society was defined as normal, and violations of it labelled deviant. For women, this meant the risk of being labelled mad if one stepped outside the bounds of a very narrow definition of femininity […]. Moral management was designed to re-educate the mad into the conforming to society, in the case of the female, into conforming to the notion of the ‘ideal woman’.340

      This situation had clear implications for treatment, as ‘moral management aimed to re-educate deviant women to conform to Victorian society. Of necessity, this meant educating women to conform to the ideals of the prevailing ideology of femininity. As a result of this, the treatment women received in Irish asylums, being orientated to this end, was essentially gendered’.341

      The issue of gender was raised explicitly in 1891 by the Inspectors of Lunatics who reported that in Ireland 54 per cent of ‘pauper patients’ were male, compared to just 49 per cent in Scotland and 45 per cent in England:342

      That the number of males admitted should exceed the females cannot be explained by any difference in the form of disease occurring in Ireland. On the contrary, we find that General Paralysis [neuropsychiatric disorder resulting from late stage syphilis] – a disease to which the male sex is particularly prone – occurs with much greater frequency in England and Scotland. […] The explanation of this relative excess of male patients would appear to us to be found in the cumbrous and difficult procedures necessary to obtain admission to public asylums in Ireland; so that the women, more easily controlled in their homes or contributing less to family support, remain at home or gravitate to the workhouses.343

      The links between gender and women’s asylum experiences and, indeed, risk of committal, was by no means limited to Ireland, as interpretations of psychological distress in women differed systematically from those in men in many countries, especially as the profession of psychiatry emerged and established itself within the medical firmament during the 1800s and 1900s.344 This persisted beyond the 1800s: Hanniffy, for example, notes a diagnosis of ‘climacteric insanity melancholia’ in the records of St Fintan’s, Portlaoise in June 1924, apparently the first occurrence of a diagnosis linked to the menopause in the asylum’s books.345

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