Irish Insanity

1800–2000

Damien Brennan, Damien Brennan

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136237072
• Edition: 1
• Topic: History
• Subtopic: Irish History
• Index: History

The national public asylum system in Ireland was established during the early nineteenth century and continued to operate up to the close of the twentieth century. These asylums / mental hospitals were a significant physical and social feature of Irish communities. They were used intensively and provided a convenient form of institutional intervention to manage a host of social problems.

Irish Insanity identifies the long-term trends in institutional residency through the development of a detailed empirical data set, based on an analysis of original copies of the reports of Inspector of Asylums/Mental Hospitals in Ireland. Damien Brennan explores core social and historical features linked to this data including:

• the political context
• governance and social policy
• the relationship between church and state
• changing economic structures and social deprivation
• professionalization
• legislation and systems of admission and discharge
• categorisation and diagnostic criteria
• international developments
• family dynamics

This book demonstrates that the actual rate of asylum utilisation in Ireland was the highest by international standards, but challenges the idea that an "epidemic of Irish insanity" actually existed. Offering a historical and sociological insight into an institutional legacy that is unusual within the international context, this book will be of particular relevance and interest to scholars within the fields of sociology, criminology, law, history, Irish studies, social policy, anthropology, nursing and medicine.

1 Theories of Irish insanity

Introduction

An understanding of Irish insanity requires a robust engagement with the ‘social facts’ pertinent to asylum expansion and demise in Ireland, an analysis of the various social forces that underpinned this trajectory and a consideration of the roles, functions and inter-dependencies that these institutions had with the communities in which they were situated. The details regarding the empirical facts of Irish asylum usage are set out in Chapter 2 and the social forces underpinning these facts are explored in Chapters 3 and 4. Two bodies of work are of particular importance when exploring this field of interest: sociological theory that addresses insanity and asylum institutions; and literature that considers the particular trajectory of the Irish asylum system. Some of the major contributions of these two bodies of work are now explored as a means of creating an overview of the theoretical approaches pertinent to understanding insanity in Ireland.

Social theory: insanity and asylums

It is not by confining one’s neighbour that one is convinced of one’s own sanity.

(Foucault 1967: xi)

In Madness and Civilisation (Foucault 1967: first published in French 1961) Foucault locates madness within a social context and discusses the social construction of insanity with reference to a spectrum of social events, structures and representations. He proposes that the perceived common sense of insanity, and responses to it, may be understood in the context of the production and reproduction of structures and practices. These structures and practices are embedded in social norms, professional occupational security, economics, law and the built environments in which particular practices are formed and reproduced. Within such structures and practices a belief in the ‘truth’ of insanity emerges and consequently the authority, respect and perceived altruism of those who respond to insanity becomes unquestionable.

Madness, as the fixed point of reference, is problematised by Foucault, who argues that such a reference point reduces the concept of sanity to a state of deviation from insanity. This critical approach argues that an analysis of insanity must be considered through a process that transcends the acceptance of the diagnostic language of modern psychiatry as neutral and value-free. Language, particularly bio-medical diagnostic categories, should therefore be constituted as the object of inquiry rather than the conceptual means of inquiry. Medical language addressing insanity is illuminated as a system of power that is developed and spoken by professional groups who have a vested interest in the power that these words can produce.

The emergence of asylums for the insane is linked by Foucault (1967) to the historical legacy of institutional provision for leprosy. He argues that the apparatus of segregation including classification, social policy, professional practice and institution building, migrated from a focus on leprosy to other areas of ‘social deviance’ particularly insanity. A key aspect of this observation is the reproduction of demand for professional medical practice which migrates from the confinement of lepers to the confinement of the insane. The power of medics to classify what is socially deviant, to order institutional confinement and to manage the institute, has created a monopoly over supply and demand for medical practice, which was first secured in leprosaria and then reasserted in asylums. While Foucault’s observation concerning this generation of professional power is of relevance to the medical takeover of Irish asylums in the mid nineteenth century, his particular reference to leprosy has limited application to the Irish context as there was no extensive programme of leprosaria construction in Ireland. The development of Irish asylums in the early nineteenth century is interesting in this regard, as it was a new innovation rather than being established upon the remnants of any pre-existing institutional system.

Foucault goes on to observe that at the commencement of asylum construction, there was no specialist expertise within medicine that placed this profession in a special position to claim governance over these institutions. Drawing from this observation, the shift in control of Irish asylums during the mid nineteenth century, from ‘lay moral management’ to professional medical ‘clinical’ management, is considered in detail in Chapter 3. Essentially, the medical take-over of asylums had little to do with professional competence, rather it was a political process revolving around medical occupational interests and professional power. A consequence of this medical take-over of asylums was the later development of psychiatry as a specialised area of medicine within the asylum. In Chapter 4 a further contemporary migration of clinical practice is explored with reference to the generation of new areas of practice within modern psychiatry and psychiatric nursing. The loss of the asylum institution as a location of occupational security is paralleled with a growth in areas of practice beyond the asylum, such as mental health promotion, the diagnosis of aspects of behaviours in childhood including ‘attention deficit disorder’, and increasing surveillance of, intervention in and regulation of human emotions such as sadness. This migration of professional practice occurred in the absence of a critical evaluation of the usefulness of psychiatry to these areas of social life. Indeed the appropriateness or otherwise of post institutional professional practice is of secondary concern to mental health professionals whose occupational security is dependent on the maintenance of the demand–supply monopoly for their practice.

The dynamic relationship between asylum institutions and economic life is also considered by Foucault. The asylum institution is problematised as a place that generates employment as well as being an economic opportunity for those interested in entering the business of private asylum provision within this trade in insanity. Asylum institutionalisation is also explored as a process that removes people without occupational or labour functionality from the capitalist market place. This serves to maintain the supply and demand dynamic of labour provision that is required for the success of capitalism, which cannot exist in the presence of a cohort of individuals allowed to remain in a state of non-productivity. Hence, the asylum provides a stigmatised site for containing such individuals, thus removing them and their threat to the economic reality required by market-based economies.

However, conversely, the asylum also served as an arena that utilised inmates in mandatory productive labour. Foucault points out that the availability of such free labour within the asylum can actually provide a comparative economic advantage over capitalists engaged in the production of similar goods or services outside the institution. Such programmes of compulsory labour were common in Irish asylums throughout the nineteenth and twentieth centuries, described now as ‘industrial therapy’. This labour included factory-based and agricultural work which is explored in Chapters 3 and 4. Interestingly, while much of this work took place within asylums, patient labour in Ireland was also sub-contracted to factory units and farms outside the asylum. As such, those once perceived as unproductive were institutionalised and then became a source of cheap productive labour.

In practice the asylum institution had many economic dynamics. It was a place of opportunity for capitalists prepared to privately supply asylum services; it is a place of occupational employment for those directly employed within the institutions; it is a place that maintains a competitive labour market by providing a refuge for the unemployable within communities; and it is a place where free labour is expected from inmates.

The interface between industrialisation, advanced capitalism and asylum growth is also considered by Scull (1979). He argues that it is not simply the emergence of industrialisation and large urban centres that stimulated asylum growth, but the impact that capitalist economics had on the commercialisation of human social life. This capitalist economic dynamic served to fragment the patterns of caring within the traditional family, both within urban and rural communities. However Ireland did not experience a classic pattern of capitalist development, and this economic dynamic was not a characteristic of Irish family life. During the nineteenth, and for much of the twentieth century, Ireland remained rural with a comparatively limited penetration of capitalism at the national, community and family level. Indeed the traditional family unit continued be the principal social force up until at least the late twentieth century. Acknowledging this, Scull notes that ‘The market system spread to incorporate all but the Celtic fringe’ (Scull 1979: 30).

The linking of advanced capitalism with asylum expansion is therefore problematic when applied to the Irish case. One would anticipate a comparatively conservative level of asylum residency in Ireland – with its restricted scale of industrialisation and the limited capitalist economic dynamic, particularly in rural areas. However, as is set out in Chapter 3, asylum expansion in Ireland was very intensive by international standards, Ireland having the highest level of mental hospital bed availability per 100,000 when compared to any other country (Table 2.2). This was most acute in the rural, non-industrialised regions within Ireland. Indeed the statistics presented in Table 2.2 would appear to contradict the connection between asylum utilisation and ‘a mature capitalist market economy’. This table sets out the results of an analysis of the level of psychiatric bed availability in 84 countries for the year 1955; Ireland having the highest. Indeed the application of any unifying economic theory concerning asylum construction would seem problematic given the fact that the highest rates of asylum institutionalisation occurred in Ireland, followed by the USSR and then USA, which were locations of radically differing social, political, historical and economic orientations.

In the context of ‘deviance’, Foucault examined the role of religious organisations in the provision of institutional services. The dual roles engaged in by religious organisations are identified and problematised – firstly their capacity to establish what is moral and sane vis-à-vis what is immoral and insane, and secondly their involvement in providing services to such categorised individuals. This proposal is developed by Foucault with particular reference to the French experience of institutional confinement. However, this contrasts with the experience of Ireland, which did not develop its national asylum infrastructure in conjunction with established religious bureaucracies. While the theme of the service provider’s vested interest in the continuation of the asylum project is relevant to the Irish context, Foucault’s analysis of church enterprise in asylum provision is not directly transferable to the Irish experience. Although asylum provision in Ireland was expansive by international standards, it was one of the few social interventions not dominated by the Church. This is explored in more detail in Chapter 3.

As far as the phenomenology of ‘mental illness’ is concerned, Foucault does not dispute the existence of human experiences such as hallucinations or profound sadness. A similar argument is made by Turner, who proposes that ‘having recognised the importance of cultural categories, I wish to retain a foundationalist epistemology and phenomenology of the body, because I want to retain the view that body pain, for example, cannot be properly understood as only socially constructed’ (Turner 1995: 18). As such, human experiences such as sadness, anxiety or pain are not disputed, but the use of medical language as a means of constructing such experiences as ‘deviant’ is problematised. For example, human emotion or passion was perceived as ‘insanity’ in an age where reason and rationality are prescribed as fixed parameters in which individuals must negotiate their sane and rational lives. Drawing on this approach, this book does not dispute that human distress, both mental and emotional, can be experienced by individuals. Furthermore it is not disputed that various forms of intervention can assist the individual in living through mental and emotional distress. However the social construction of these experiences as deviant is channelled and professional monopolies, social policies, institutional environments and community involvement in asylum institutionalisation are critically explored.

Several lines of critical analysis can be drawn from Madness and Civilisation: asylums are identified as types of warehouses for the ‘asocial’; the application of enlightenment ideas to such institutions (cure and care) is deconstructed; the medical takeover of asylums is made political; and the application of scientific medicine to perceived insanity is problematised. This critical examination of the medicalistion of human life is further developed in Birth of the Clinic (Foucault 1973) which is particularly concerned with exploring the conditions that provide the possibility of medical dominance in contemporary societies. The emergence of systems and rules of classification, which underpin medical theory and practice, are critically unpacked. In particular the ‘clinical gaze’ which involves various forms of examination/surveillance, is explored as a power process. The political environment of professional medicine and the built environment of the hospital are also considered as providing an opportune structure for the event of medical domination over areas of life such as birth, death, health and illness. Drawing from Foucault’s analysis, medical dominance within Irish asylums is considered in Chapter 3, with particular reference to the official policy to ‘advance medical sciences in the case of lunacy, through the great range of experience which the public Asylums afford’ (Inspectors-General 1844: 46).

In The Birth of the Clinic Foucault also considers the nature of epidemic as a social event. A description is provided of the setting up of groups of doctors to monitor and intervene in epidemics in France during the late eighteenth century. Foucault makes a connection between the personal body and the political or social reality of epidemic and goes on to illuminate how medics gained a monopoly of practice over both physical and social aspects of human life. As such, medical practice is proposed as a socially constructed technical set of skills and knowledge, and equally as a political process that is linked to wider political opportunities. Medical practice is observed as moving from the context of the healthy body to the context of normality, to which the body must be adjusted. This migration of practice, from the individual body to the society, is interesting if one considers the contemporary shift of psychiatric practice in Ireland to areas of life such as mental health promotion and suicide prevention. In Chapter 4, it is argued that this is primarily driven by professionals’ concern for occupational security. Having lost their main source of practice within the asylum, these professional groups have been proactive in developing new markets for psychiatric intervention.

Traditionally the location for diagnosing and dealing with health and illness was the family unit, whose members were co-dependent in a manner that enabled mutual care provision. It would be unwise to suggest that mutual care was the sole feature of Irish family life. Indeed the family unit provided the context for most aspects of social life including birth, death, education, labour, and love but also abuse and neglect. However, the development of scientific classification systems and the built environment of the hospital relieved the family of this duty of care during times of illness. Indeed the ideology of altruistic and advanced scientific medical practice places a moral duty on the family to surrender the care of their kin to the ‘expert’ knowledge of the well-equipped practitioner.

Foucault’s work on the historical trajectory of insanity, the nature of madness and power, particularly within the context of professional medicine, is significant in providing understandings of insanity that transcend the individual mental state. His consideration of a spectrum of social events provides a multi-layered analysis of insanity, mediated by power, situated and reproduced within structures such as professional bodies, law, religion, governance, built environments and represented through literature, mythology and in particular histories. Such an approach is extremely useful when considering the Irish case as it provides a theoretical foundation to enable an analysis of ‘mental illness’ not bound by the individual mental state or human flesh.

An analysis of the trajectory of institutional residency for the insane in Ireland also requires a consideration of the internal social life of individual asylum institutions. Sociological theory addressing institutional social life was significantly progressed by Erving Goffman during the early 1960s, particularly his seminal research at St Elizabeth’s Psychiatric Hospital USA. Drawing from the anthropological tradition, this observational study sought to illuminate the social world of the psychiatric hospital and to explore patients’ subjective experiences of life in such institutions. Goffman observed that the normal division of authority over various aspects of social life is undermined within the asylum. Within asylums the institution gains a monopoly of authority and becomes the singular controlling force under which the patient must negotiate various aspects of their day–to-day life.

A basic social arrangement in modern society is that the individual tends to sleep, play and work in different places, with different co-participants, under different authorities, and without an overall rational plan. The central feature of total institutions can be described as a breakdown of the barriers ordinaril...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of illustrations
• Preface
• Acknowledgements
• Introduction
• 1. Theories of Irish insanity
• 2. Irish asylum utilisation 1800–2000
• 3. The Irish insanity ‘epidemic’ 1800–1956
• 4. The demise of Irish insanity 1956–2000
• 5. Conclusion
• Appendix: Tables of data
• Bibliography
• Index