A pioneer of psychiatry in Ireland

The contributions of the late Dr Des McGrath to the specialty of psychiatry in this country were enormous

I was deeply saddened to read of the death of Dr Sean Desmond (Des) McGrath, a distinguished psychiatrist who will be familiar to many readers. McGrath was Medical Director of St John of God Hospital in Stillorgan, where he first took up a post in the mid1950s. He retired in the 1990s and died in September 2021, in his 100th year.

McGrath was a remarkable person. Over the course of his long career, psychiatry in Ireland changed dramatically, and McGrath was a key part of that shift over several decades. To appreciate the context, it is useful to remember that these were times of radical transformation in the Irish mental health system.

At national level, the number of inpatients across the country fell from 19,801 in 1963, to a relatively low total of 4,256 in 2001. The nature of service provision also changed, not least because the independent sector developed considerably from the middle of the 20th Century onwards. St John of God Hospital and McGrath were key agents of that change.

St John of God Hospital has a long, distinguished history. The Brothers of St John of God first established a private psychiatric hospital in Stillorgan, Co Dublin in 1882. The Order already had an extensive history of assisting the mentally ill in France and elsewhere, so this was not an entirely new departure for them.

The Stillorgan hospital progressed well from the outset.

It was recognised by the Royal Medico-Psychological Association (RMPA) in 1926. In 1950, the hospital hosted a prestigious three-day psychiatric congress, including an official RMPA meeting. Six years later, it became the first psychiatric hospital in Ireland to introduce the “open-door system”. This involved according greater liberty to patients, expanding occupational and recreational therapies, and increasing group activities. The new system met with notable success.

When McGrath took up a post at St John of God in 1955, the hospital had just 132 admissions per year. McGrath, however, proved to be an outstanding clinician, trainer, and service developer, and he consolidated St John of God Hospital as a pioneer in teaching and developing psychiatry in Ireland and beyond. By the time McGrath retired in the 1990s, the hospital had approximately 1,750 admissions per year.

By 1997, there were 210 beds at the hospital, including inpatient provision for the innovative Cluain Mhuire community mental health service. The Inspector of Mental Hospitals noted that “the quality of inpatient accommodation at St John of God was very high and continuous improvements were being made”. The hospital developed speciality services in addictions, adolescent mental health, eating disorders, psychiatry of later life, psychosis, stress management, wellness and recovery programmes, and programmes for mindfulness and relaxation.

McGrath was central to many of these changes, but his contributions to the development of psychiatry extend well beyond the hospital that he led so skilfully. I would like to draw attention to a book that he co-edited in 1963, titled The Priest and Mental Health, as just one example of his broader contributions. Published by Alba House in New York, this remarkable volume was edited by the Reverend E F O’Doherty, UCD Professor of Logic and Psychology, and McGrath. It richly merits renewed attention today.

The volume opens with an introduction by John C McQuaid, Archbishop of Dublin and Primate of Ireland. McQuaid points out that “St Thomas, in dealing with the passions, treats them as passiones animae, the passions of the soul. That, I submit, is the most fundamental concept of true psychotherapy”.

Further contributions to the book focus on “the priest and mental health” (O’Doherty), “diseases of the mind” (Professor John Dunne), “early symptoms of psychological disorders” (McGrath), and “child psychiatry” (Dr John J Stack). There is a strong religious dimension to certain chapters, looking at “psychoanalysis, psychotherapy, and spiritual direction”, “confessional problems of the mentally ill”, and “the mental hospital chaplain”.

There are also considerations of “marriage problems”, “alcoholism”, and “the problem of scruples”, among other issues Perhaps the most interesting contribution comes from McGrath himself, where he explores “current developments in psychiatry”. McGrath writes in detail about novel physical and pharmacological treatments, as well as the “open door system” and day hospitals. He finishes by drawing attention to the centrality of the patient, who lies at the very heart of care: “If the individual and his personal problems are lost sight of, no amount of physical or pharmacological treatment will be effective.”

This sentiment is a fitting reflection of a life that was devoted to caring for the mentally ill, training a new generation of psychiatrists, and improving our understanding of mental ill-health. McGrath’s contributions were enormous. Irish
psychiatry is profoundly in his debt.

Prof Brendan Kelly is Professor of Psychiatry in Trinity College Dublin and author of Hearing Voices: The History of Psychiatry in Ireland (Irish Academic Press).