A look inside Grangegorman

The story of Ireland’s asylum system is awkward, complex, and contested

The “mental hospitals” of the 19th Century and early 20th Century are Ireland’s awkward institutions. They were designed to treat and contain the mentally ill but soon assumed a life of their own: Meeting the complex needs of troubled families (often unrelated to mental illness); alleviating social problems in surrounding communities (especially during times of poverty, famine, or political unrest); and – possibly most of all – supporting local economies by employing tens of thousands of people, often in areas with limited alternative employment.

Ireland’s enormous asylums were secular institutions, run by government, so it is not possible to place responsibility with the Roman Catholic Church, which is commonly associated with many of the excesses of Ireland’s institutional past. The church never became deeply involved in the asylums, its attention occupied, perhaps, by its extensive involvement in general hospitals, maternity care, schools, orphanages, and laundries. Or perhaps the mentally ill were seen as undeserving? In any case, the story of the Irish asylums is more complex and troubling than any simple explanation permits.

Even the language we use to discuss the asylums is contested and uneasy. Acceptable terminology moved from “lunatic asylums” to “district asylums” to “mental hospitals” to “psychiatric institutions” and, finally, to “inpatient mental health units”. People suffered from “madness”, then “lunacy”, then “psychiatric illness”, and now “mental disorder”. And there were, at all times, a range of other, less acceptable, and frankly offensive terms. In all respects, the story of Ireland’s asylum system is awkward, complex, and contested.

But it is also a story about well-intentioned efforts to care for the mentally ill, house the destitute, accommodate the intellectually disabled, and provide “asylum” to people whom society was only too ready to label as odd, different, and “other”.

The stories of these people fill my new book, Asylum: Inside Grangegorman”(Royal Irish Academy). This is primarily a book about people, telling its tale through case histories drawn from the archives of the Richmond District Asylum in Grangegorman, Dublin, the establishment that lay at the heart of Ireland’s network of institutions for the mentally ill. The Richmond was where new treatments were introduced, novel ideas developed, and more patients treated than at any other asylum in the country. For better or for worse, the Richmond, also known as “Grangegorman” and “St Brendan’s Hospital”, set the tone for Ireland’s mass institutionalisation of the mentally ill throughout the 1800s and 1900s.

The stories are both extraordinary and disturbing. In the late 1850s, for example, four decades after the asylum opened, Máire A, a 23-year-old single “servant” was admitted to the Richmond. Máire was transferred from the neighbouring Richmond Penitentiary (prison) and diagnosed with “melancholia”, cause “unknown”. On admission to the Richmond, Máire’s “reaction to questions” was “fairly prompt and coherent”. She was “not devoid of intelligence” but had “a slight tendency to hypochondriasis”.

The medical notes record the stark circumstances under which Máire was declared a “dangerous lunatic” and committed to the asylum:

“She describes clearly the incident of her brother asking her to come for a walk with him and then taking her to the police office. Her hair was shaved off and she was detained in the jail. After some years she was transferred here. She says that previous to her arrest, something very terrible was in her and wouldn’t let her rest in the bed and made her break a window. She speaks as if of some force possessing her, though she denies that it was the devil.”

In the asylum, Máire was “an industrious working patient for many years”. She was “very tidy and respectable in appearance”, with “mild chronic melancholia”.

But despite the “mildness” of Máire’s diagnosis, her good conduct, and her industriousness, she was to spend the rest of her life in the cramped, crowded wards of the Richmond: Devoid of personal possessions, deprived of privacy, with straw for bedding, and with no control over her daily routine. Máire took her meals in vast, noisy dining halls, washed in communal bathrooms, and slept on wards that were crowded, disturbed, and often dangerous. With wearying inevitability, Máire eventually died in the institution, succumbing to “heart disease” at the age of 68, some 45 years after she was admitted.

Máire’s story was not an unusual one in Ireland or elsewhere during the 19th Century. But while many countries established asylums for the mentally ill during this period, Ireland’s rate of admission rose faster than in other countries, was higher at its peak, and was slower to decline. How did this happen?

Many of these questions remain unanswered, even today. In Asylum: Inside Grangegorman I explore these issues and, especially, some of the human stories of Ireland’s forgotten institutions: The “mental hospitals”.

Prof Brendan Kelly is Professor of Psychiatry at Trinity College Dublin and author of Asylum: Inside Grangegorman (Royal Irish Academy, 2023) www.ria.ie/asylum-inside-grangegorman-pre-order