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Hearing Voices. Brendan Kelly
Читать онлайн.Название Hearing Voices
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isbn 9781911024446
Автор произведения Brendan Kelly
Издательство Ingram
From a methodological perspective, there are many possible approaches to my task and to the history of medicine in general, ranging from exclusively medical perspectives, charting the evolution of treatments over time, to exclusively sociological approaches, which prioritise the social and political contexts in which medicine and healthcare develop and are practiced. Like most historical texts, this book lies somewhere between these extremes.
From a thematic perspective, Burnham identified five key ‘dramas’ in the history of medicine, relating to the histories of (a) the healer; (b) the sick person; (c) various diseases; (d) discovery and communication of knowledge; and (e) interactions between medicine and health on the one hand, and society on the other.90 All of these ‘dramas’ are reflected in a variety of ways throughout this book, with particular emphasis on interactions between psychiatry and society, owing to the intrinsically societal basis of the Irish asylums of the 1800s and 1900s, and the social roles commonly foisted upon (and all too often accepted by) psychiatry, no matter how unsuitable those roles are. This regrettable feature of the history of psychiatry is a recurring theme in my story.
Chapter 1 of the book commences by exploring the ‘birth of psychiatry in Ireland’ and covers the Middle Ages and early modern era, Gleann na nGealt and Mad Sweeney (in the twelfth century), and Brehon Law (up to the seventeenth century). The emergence of new forms of institutional care is explored, as are the lives and work of Sir William Fownes and Jonathan Swift, especially in the context of St Patrick’s Hospital, Dublin (1746). Burnham’s ‘drama’ of the healer features strongly in the form of Dr William Saunders Hallaran and the succession of therapeutic enthusiasms for new treatments that emerged in the late 1700s and early 1800s in Ireland, as was also the case elsewhere.
Chapter 2 moves on to examine the growth of the asylums in nineteenth-century Ireland, commencing with the Richmond Asylum (1814) and examining the work of pivotal figures such as Dr Alexander Jackson, Robert Peel (Chief Secretary, 1812–17) and Dr John Mollan at the Richmond. Other notable developments included the Select Committee on the Lunatic Poor in Ireland (1817), the Dangerous Lunatic Act 1838, the Private Lunatic Asylums (Ireland) Act 1842, the 1843 report on the ‘State of the Lunatic Poor in Ireland’, the 1851 census and the 1858 Commission of Inquiry on the State of Lunatic Asylums in Ireland. The ‘drama’ of the patient is explored through the use of archival case records and case studies of restraint, ‘neglect and cruelty’, as well as folie à plusieurs, an unusual psychiatric syndrome which, in these cases, was associated with the killing of family members. This chapter also examines treatments for mental disorder, life and death in the institutions, and the experiences of women in nineteenth-century asylums.
Chapter 3 moves explicitly to the ‘drama’ of the interactions between psychiatry and society, looking at the effects, if any, of the Great Irish Famine (1845–52) on admission rates, workhouses, treatment of the intellectually disabled, and widespread alarm about the alleged ‘increase of insanity in Ireland’ during the late 1800s and early 1900s. This chapter also reflects on why the Irish asylums grew so large; outlines (in detail) psychiatric diagnoses from the archives of Carlow Lunatic Asylum in the late 1800s; explores the histories of Bloomfield (1812) and Hampstead Hospitals (1825); and examines Burnham’s ‘drama’ of the healer by looking at the contributions of Dr Thomas Drapes, Dr Conolly Norman and Dr Eleonora Fleury, a remarkable republican doctor and first woman member of the Medico-Psychological Association (MPA, 1894).
Chapter 3 also presents the case of Mary, a 40-year-old ‘housekeeper’ with seven children who was charged with the manslaughter of her 4-year-old child in the mid-1890s. Mary was ‘acquitted on the grounds of insanity’ and detained at the Central Criminal Lunatic Asylum (later Central Mental Hospital, Dundrum) ‘at Her Majesty’s Pleasure’ (i.e. indefinitely). Mary’s admission diagnosis was ‘chronic melancholia’, and examination of her archival case records in this chapter questions the nature of this diagnosis and uses Mary’s story to illustrate diagnostic challenges in the late 1800s, along with difficulties separating mental disorder from social and economic problems, especially among women, during this difficult period in Irish psychiatric history.
Chapter 4 explores ‘early twentieth-century psychiatry’, setting the scene with consideration of the remarkably insightful (but sadly ignored) Reports of the Committee Appointed by the Lord Lieutenant of Ireland on Lunacy Administration (1891).91 Chapter 4 then outlines the fate of the mentally ill outside the asylums in the early 1900s, the Conference of the Irish Asylum Committees (1903) and key issues at the Richmond District Asylum (Grangegorman) in 1907. In terms of the links between psychiatry and broader sociohistorical events, this chapter outlines the effects of the 1916 Easter Rising on Dublin’s asylums; the story of the Richmond War Hospital (1916–19); the remarkable life and career of Dr Ada English, patriot and psychiatrist in Ballinasloe; and the broader relevance of nationalist sentiment throughout the asylum system during Ireland’s revolutionary years.
Again, Burnham’s ‘drama’ of the sick person is explored throughout this material, especially through the case study of Michael, a 35-year-old man committed to the Central Criminal Lunatic Asylum in the 1890s, charged with ‘assault’; declared ‘insane on arraignment’; and diagnosed as a ‘congenital imbecile’. Michael’s story, based on archival clinical records, demonstrates many important features of Irish asylum life in the late 1800s and early 1900s, especially as they relate to persons with apparent intellectual disability. The experiences of the intellectually disabled feature repeatedly (and disturbingly) throughout the story told in this book.
Chapter 5 moves on to examine efforts at reform of Ireland’s mental health services in the early 1900s, looking at multiple sources of evidence including media articles, developments relating to the intellectually disabled, and accounts of industrial unrest (e.g. the Monaghan Asylum Soviet, 1919). Burnham’s ‘drama’ of the healer is explored through the work of Professor John Dunne in Grangegorman and, in relation to occupational therapy, Drs Eamonn O’Sullivan in Killarney and Ada English in Ballinasloe. This chapter also explores therapeutic enthusiasms for some of the most controversial treatments in the history of psychiatry (psychotherapy, malarial treatment, insulin coma, convulsive therapy, lobotomy); the reforming efforts of the Mental Treatment Act 1945 and the Commission of Inquiry on Mental Illness (1966); and, in the independent sector, the development of St Patrick’s Hospital, Dublin during the twentieth century.
Chapter 6 documents the ‘decline of the institutions’ in the late 1900s and explores various factors that contributed to this, including the advent of effective antipsychotic medication, and changing public and press perceptions of psychiatry. The patient’s voice is heard through first-person accounts of psychiatric hospitalisation provided by the Reverend Clarence Duffy (1944) and Hanna Greally (1971).
This chapter also examines Irish psychiatry in relation to homosexuality, explores the remarkably persistent idea that mental illness was more common in certain parts of Ireland than elsewhere, and looks at the figures who led various reforms within Ireland’s mental health services, including, but by no means limited to, Dr Dermot Walsh, Professor Ivor Browne, Dr Des McGrath, Professor Thomas Lynch, Professor Thomas Fahy, Dr Robert McCarthy, Professor Robert Daly, Dr Brian O’Shea, Professor John P. (Seán) Malone, Professor Noel Walsh, Professor Marcus Webb and Professor Eadbhard O’Callaghan.