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Hearing Voices: The History of Psychiatry in Ireland

Prof Brendan Kelly has produced a series of books over a short number of years on various topics including the psychiatrist Ada English, the war hospital in Grangegorman, mental health legislation and human rights. His output has been such that it was clear he was building up to something big. Prof Kelly’s volume on the history of psychiatry in Ireland is indeed a big book, yet the would-be reader ought not to be intimidated. The structure of the book is such that chapters can be read as stand-alone essays. Moreover, chapters have subdivisions of three-to-four pages, each dealing with biographies or events.

Even so, this book adopts an essentially longitudinal narrative, beginning with the management of the psychologically unwell by druids and healing locations in the Middle Ages (including an old favourite of mine from At Swim-Two-Birds, Mad Sweeney) and finishing with more recent legislation and training structures. It is to Prof Kelly’s credit that he has allocated so much of the book to these more recent developments. He was in a unique position to write this book, being a professor of psychiatry with a history qualification to PhD level.

Chapters two and three examine the development of asylum-based treatment in 19th Century Ireland in the public and private sectors, with Prof Kelly’s particular interest in the practice of detention in psychiatry having a significant influence on the text.

Chapter four focuses on early 20th Century psychiatry, with informative diversions into elements of Irish socio-political history, such as the role of the asylums with regard to the growth of nationalist sentiment.

As this chapter and further chapters proceed, we get to see the importance of government reports and policy documents in the development of psychiatric care. Landmark documents (Planning and Vision) and legislative changes (1945 and 2001) receive due attention. As well as major documents from the government ‘side’, other lesser-known works such as the wonderful account of his involuntary detention written by the Reverend Clarence Duffy in 1944 are included. 

I can make few criticisms and none with respect to the factual content in the text. It is clear to me that the material presented has been checked by Prof Kelly repeatedly.

Initially, I observed a slight bias in favour of the late 19th Century with respect to the illustrations. Furthermore, I thought it odd that of the 47 illustrations used, 14 are Lawrence collection photographs of various 19th Century asylums throughout the country. On reflection, when displayed in a series such as this, these photographs do illustrate the impressive scale of the asylum system and the imposing nature of their architecture on local populations, but I do wonder about the value of presenting photographs of all these asylums when there are no photographs of any of the hundreds of facilities, inpatient and outpatient, built by the health boards and the HSE over the years. In fact, for some reason, not one photograph represents a mental healthcare building provided by the HSE or its precedents since the foundation of the State. This goes against the generally optimistic tone of the text in later chapters.

Amongst the last section of illustrations, the author has chosen an image from Personal Effects: A History of Possession by the artist Alan Counihan. The work features an early 20th Century photo of an unknown seated woman with her face altered such that it is featureless and therefore, I assume, representing the psychiatric patient without identity in the psychiatric system. There is some irony therefore in the four photos of early 20th Century (1906-1908) patients presented on earlier pages. Again, the faces of the individuals are lost to us but this time it has been decided to crop out their entire heads “for the purposes of confidentiality”.

Hearing Voices has been excellently proofread and edited by Irish Academic Press and is very readable, especially its early chapters. The indexing (a time-consuming and difficult task) is comprehensive.

The publishers decided to use endnotes rather than footnotes, which on balance was probably wise, due to the sheer quantity of material referenced. On average, there are 318 references per chapter and Prof Kelly has included many hundreds of primary sources, university theses, newspaper articles, personal interviews and secondary sources. The bibliography itself stands alone as a compendium of material on the history and development of Irish psychiatric care and will be of use for generations to come.

Frequently after a book has been published — and especially a history book — the author finds material that they would have wished to include. This is unlikely to happen to Prof Kelly too often, as he appears to have spared no time in trawling archives and other publications for every piece of information that could contribute. I was particularly glad to see Michael Viney’s columns from The Irish Times receiving appropriate recognition.

In 1986, my fellow county-man (and relative by marriage) Joe Robins produced his authoritative work on the history of the care of the mentally ill in Ireland, Fools & Mad: A History of the Insane in Ireland. I’m sure he wouldn’t object if I declared his book greatly augmented by Prof Kelly’s work.

Dr Aidan Collins published a history of St Vincent’s Hospital, Fairview, in 2007.

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