An illuminating look inside the walls of Grangegorman

When I was growing up in Dublin, references to Grangegorman were rarely to the area. The more usual verbal reference was either slightly threatening, condescending, or somewhat fearful. It was often described in what we now would correctly regard as offensive language.

Despite my subsequent medical training and better understanding of psychiatry, it surprises me how clear those 40 odd year-old memories are. Prof Brendan Kelly’s latest book, Asylum – Inside Grangegorman, is a chance to see behind the walled-off institution and to get a better understanding of Dublin’s district asylum.

Recently published by the Royal Irish Academy, the book includes some anonymised patient case histories as well as quotations from resident medical superintendents (RMSs), all of which help to bring it to life.

“Mental asylums are Ireland’s awkward institutions,” Kelly writes. They assumed a life of their own, well beyond the treatment of mental illness. Meeting the complex needs of troubled families (often unrelated to mental illness) and alleviating social problems became the raison d’etre of mental institutions.

Kelly uses the case of Máire A, who was 23 when she was admitted to Grangegorman with ‘melancholia – cause unknown’, as the spine of his book. Subsequent medical notes refer to her as having “mild chronic melancholia” and being “an industrious working patient”. Despite the mildness of her diagnosis, she remained incarcerated for another 45 years, before dying in the asylum aged 68.

“This book tries to make sense of the story of Máire A and the many others like her who found themselves caught up in Ireland’s extraordinary and sometimes shameful system. These are the stories of people who were, for various reasons, consigned to institutions, often for several decades if not for life – with doctors unable to discharge them home and families either unable or unwilling to take them back,” the Trinity College Dublin Professor in Psychiatry writes.

One of the more enlightened RMSs was Dr Connolly Norman, who was in post from 1886 to 1908. The leading psychiatrist of his generation, Connolly features heavily in the book. He was deeply opposed to prolonged asylum admission. However, his efforts to change the system were rejected by a society and government committed to institutionalisation. One of his successors, Prof John Dunne (1937-1965), introduced better living conditions for patients in Grangegorman. He had singular success in finally reducing inpatient numbers, from over 2,000 in 1937 to some 700 when he retired in 1965.

The extremely broad social reasons for admission to Grangegorman in the early 1800s included domestic disagreements, jealousy, pride, and “change of life consequent on marriage”. Most are well removed from mental illness. One poor man was committed for “excessive fondness of music”. It seems to this reviewer that being socially outmanoeuvred by a family member was a principal reason for admission.

Kelly sounds a warning about the need for continued access to asylum archives

The decanting of patients from what was now known as St Brendan’s continued under Prof Ivor Browne and Dr Dermot Walsh. The institution finally closed its door in 2013, leaving the modern Phoenix Care Centre in its wake.

Kelly sounds a warning about the need for continued access to asylum archives: “Despite their complexities – or more likely because of them – the buried stories of the Irish asylum patients need to be unearthed and told.”

He is right. Ireland managed to incarcerate many more people in asylums than other jurisdictions and was much slower to implement reform to a community-based model of psychiatry. This story represents a systematic disempowerment of the mentally unwell and a grossly disproportionate deprivation of liberty, despite the best efforts of asylum staff.

Ideally, future consideration of Irelands asylums would include communication from the patients. I realise this is going to be difficult to locate. Would it be possible to put together a collection of letters from patients to their relatives?

Not being a trained archivist, I’m not sure how realistic a proposal this is. But it would surely enrich the efforts of Kelly and others who seek to get behind the forbidding walls of asylums, such as Grangegorman .