Custody, care and criminality: clinical aspects of forensic psychiatric institutionalisation in late nineteenth- and early twentieth-century Ireland

Ireland experienced a rapid rise in psychiatric committals in the nineteenth and early twentieth centuries. While there have been (limited) explorations of selected aspects of the social, institutional and legislative factors underlying this phenomenon, there is a paucity of literature relating to clinical aspects. The published works in this Doctorate demonstrate that individuals committed to institutional forensic psychiatric care during the late nineteenth and early twentieth centuries (with a particular focus on women) showed evidence of social, psychiatric and medical problems. Archival case records present clear evidence of a range of medical and psychiatric disorders (including syphilis, intellectual disability, folie à plusieurs). At population level, there was significant diagnostic reclassification (from intellectual disability to mental illness) in parallel with the asylum-building of the 1800s. Other contributors to institutionalisation include the emergence of the insanity defence in Irish courts in the late 1800s and high levels of medical, psychiatric and social need outside Ireland’s system of asylum care (e.g. in workhouses), especially during the Great Famine (1845-1849). There is also evidence of therapeutic enthusiasm and institutional protectionism on the part of doctors, perpetuating Ireland’s asylum system. Key figures included Dr. William Saunders Hallaran in Cork in the early 1800s, Dr. Conolly Norman in Dublin in the early 1900s, and Professor John Dunne in Dublin in the early- to mid-1900s. Overall, individuals with mental illness and/or intellectual disability who engaged in offending behaviour in nineteenth- and early twentieth-century Ireland experienced lengthy periods of detention, high levels of mental and physical illness, and a relatively high risk of dying in the asylum, despite contemporary awareness of this problem amongst asylum managers and doctors. Archival clinical case-notes present strong evidence that medical and psychiatric need contributed substantially to this situation, alongside institutional, legislative and societal factors promoting committal.