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when it finally commenced in the 1960s, was attributable only in part to advances in clinical psychiatry (e.g. antipsychotic medication) and was more substantively shaped by broader changes in Irish society, such as the opening up of Ireland to greater outside sociopolitical influences in the 1960s and 1970s, an increasingly free press, the growth of the language of human rights across Europe, and Ireland’s accession to the European Economic Community (EEC; later European Union (EU)) in 1973. All of these themes are explored throughout this book.

      As ever, psychiatry in Ireland came to reflect these broader changes in society as they occurred, as well as advances in psychiatric care in other countries, and so the asylums finally began to empty in earnest in the 1960s. And, as usual, Irish psychiatry was not short of reform-minded doctors enthusiastic for change, as a fresh generation of psychiatrists and other mental health professionals gave shape to a new, post-institutional psychiatry in Ireland. While the pace of reform was slow, the changes were definite and duly reflected in the 1966 Report of the Commission of Inquiry on Mental Illness36 and all subsequent governmental mental health policies (which have, essentially, been re-statements of the 1966 report).37

      All of these events are explored in some detail throughout this book. Inevitably, much of the book is devoted to the emergence and ultimate demise of the Irish asylum system owing to both its magnitude and its remarkable, absorbing character. Attention is also given, however, to Irish psychiatry prior to the asylums of the 1800s, and Irish psychiatry since the demise of the large hospitals in the late 1900s, as well as current and future trends.

      The precise roles of psychiatry and psychiatrists in all of this are interesting, engaging and occasionally alarming. Rather than psychiatry shaping its own history as a distinct discipline within medicine, it often seems as if psychiatry in Ireland was, for the most part, shaped by broader social and historical trends, as opposed to developing as an autonomous, readily identifiable entity on its own terms. As a result, it is difficult, although by no means impossible, to trace out a clear identity for Irish psychiatry over past centuries.

      Notwithstanding these challenges, I hope that the historical events explored throughout the book set out the parameters for establishing such an identity, and that the analyses presented provide perspectives on both how psychiatry has evolved in Ireland and how the path to today’s psychiatry is likely to influence its future.

      Gaps in the Story

      While a growing quantity of research has focused on various aspects of the history of psychiatry in Ireland, substantial lacunae remain.38 Walsh, in his positive review of Reynolds’s invaluable book, Grangegorman: Psychiatric Care in Dublin since 1815, noted that Reynolds’s ‘worthwhile’ and ‘meticulous contribution’ did not ‘pretend to be a scholarly analytical academic work analysing the various forces shaping the intellectual and emotional attitudes to lunacy policy and its administration in Ireland in the 19th and 20th centuries’.39 Clearly, further work, likely by a range of researchers, was needed to build on the accounts of Reynolds and others and provide a clearer picture of the history of psychiatry in Ireland.

      Looking more broadly, there are, in fact, very many gaps in the historiography of Irish psychiatry. One of the key features of the literature to date is that it demonstrates a remarkably strong focus on the history of institutions, understandably echoing the emphasis that government traditionally placed on asylums as a key element in resolving the social problems presented by people with apparent mental disorder or intellectual disability. There has been particular engagement with the histories of earlier, larger institutions such as St Brendan’s Hospital, Dublin;40 St Patrick’s Hospital, Dublin;41 St Vincent’s Hospital, Fairview;42 St Davnet’s Hospital, Monaghan;43 Our Lady’s Hospital, Cork;44 St. Mary’s Hospital, Castlebar;45 Holywell Hospital, Belfast;46 St Fintan’s Hospital, Portlaoise;47 St Luke’s Hospital, Clonmel;48 and Bloomfield Hospital, Dublin,49 among others. There is also a growing literature relating to the Central Criminal Lunatic Asylum (later Central Mental Hospital [CMH]) in Dundrum, Dublin.50

      In addition to this focus on institutions, the historiography of Irish psychiatry also shows a strong focus on the evolution of mental health legislation. This, again, is entirely understandable and largely attributable to both the existence of laws permitting criminal and civil detention on the grounds of mental disorder,51 and the fact that the development of Ireland’s psychiatric institutions throughout the 1800s and 1900s52 was rooted in endless, obsessional revisions of legislation, including committal laws.53

      There are, however, other stories to be told and other perspectives to be explored, many of which are challenging to uncover. St Patrick’s Hospital in Dublin, for example, was founded following the benevolent bequest of Jonathan Swift (1667–1745), as a private, charitable institution aiming to provide high quality care to a finite number of the afflicted, without the broader, population level responsibilities of government run institutions.54 Malcolm, in her excellent, detailed history of St Patrick’s, however, found that it was noticeably difficult to reconstruct the living conditions of the patients there.55 There was a wealth of information regarding details of the building, the provision of food and so forth, but, from a clinical and historical perspective, the patients themselves proved remarkably elusive.56

      This elusiveness may reflect a lack of governmental interest in individual patients and an exuberance of interest in psychiatric hospitals as institutions. Dr William J. Coyne, chief psychiatrist and resident governor at the CMH in Dundrum, who resided at the hospital from 1949 to 1965, was, every year, in the words of his grandson, Dr Maurice Guéret, ‘hauled before politicians on the public accounts committee to explain matters like failures of the carrot crop on the hospital farm, low prices from sales of hospital sheep, victualling rations for staff and the late delivery of spring seeds. Never once was he asked a single question about his patients’.57

      As a result of these factors, the historiography of psychiatry in Ireland, as elsewhere, focuses largely on the histories of institutions and legislation, and the patients themselves remain ephemeral, elusive and largely unknown. Despite their vast numbers, patients’ voices are astonishingly distant and frequently inaudible to today’s historians. How can this be remedied?

      Searching for Patients’ Voices

      Recent decades have seen some progress towards seeking out the patients’ voices in the history of Irish psychiatry, commonly through analysis of official clinical records in certain establishments, including St Brigid’s Hospital, Ballinasloe,58 the Central Criminal Lunatic Asylum,59 St Brendan’s Hospital,60 and Enniscorthy Lunatic Asylum, County Wexford,61 among others. These are, however, analyses of official medical records, with all of their associated narrative and interpretative ambiguities.

      One of the key merits of historical research based on clinical records is that such records are uniquely useful for identifying shifts in clinical practice over time and conveying the complexity of hospital life.62 Compared to approaches framed by institutional or legislative perspectives, which are so common in the historiography of Irish psychiatry, approaches based on clinical notes move somewhat towards Porter’s conceptualisation of ‘medical history from below’,63 although they still rely on official records written by medical superintendents and others, rather than direct patient accounts, such as patients’ own correspondence or memoirs.64 Official medical records can be manipulated, consciously and unconsciously, by the individuals writing the records, to demonstrate, for example, that staff always behaved in a fashion appropriate to the doctor-patient relationship (even if they did not).65 But such accounts do, at least, seek to tell that patient’s story at the individual level, as it was experienced.

      Given these methodological issues, it is apparent that constructing an ‘authentic’ account of patient experience is a complex, challenging and possibly impossible task.66 Be that as it may, the case record still reflects both the patient’s behaviour and the interpretation of such behaviour by hospital authorities and, as such, presents a unique and crucial account of the patient’s experience – an account which generally played an important role in determining how the patient was treated in and by the institution. Archival case records are used to present patient histories throughout this book (e.g. the cases of three brothers committed to the Central Criminal Lunatic Asylum in the 1890s in Chapter 2, and that of Mary

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