Disorder Contained: Theatre Performances, Coventry, Dublin, Belfast

A Theatrical Examination of Madness, Prison and Solitary Confinement

Disorder Contained: A theatrical examination of madness, prison and solitary confinement is a major public engagement activity for the Wellcome Trust funded project Prisoners, Medical Care and Entitlement to Health in England and Ireland 1850-2000. It draws on the work of Associate Professor Catherine Cox (UCD) and Professor Hilary Marland (Warwick) and forms the final part of The Asylum Trilogy exploring various aspects of the history of mental health.

The production, created with Talking Birds and to be performed in Coventry, Dublin, Belfast, and London during 2017, will be accompanied by Expert Panel Discussions as well as Post-show Artistic Conversations which will be recorded along with the performance.

Book Tickets

• Coventry from 29 June - 1 July: Book tickets
• Dublin from 12 - 14 July: Book tickets
• Belfast on 15 July: Book tickets
• London from 9 October - 10 October: Book Tickets

See Also

• Show announcement
• Press release
• Theatre dates and tickets
• Audio flyer
• Reflective blogs (on translating historical research into accessible theatre)
• Disorder Contained: Reading

Event: Mind-Reading 2017

MIND-READING 2017: MENTAL HEALTH AND THE WRITTEN WORD

Venue: Studio Theatre, dlr LexIcon

Date: 10 March 2017

Conference Organisers:

Dr. Elizabeth Barrett (UCD) and Dr. Melissa Dickson (Oxford).

Keynote Speakers:

Prof. James V. Lucey (TCD),

Prof. Fergus Shanahan (UCC) and

Prof. Sally Shuttleworth (Oxford).

Introduction

This one-day programme of talks and workshops seeks to explore productive interactions between literature and mental health both historically and in the present day. It aims to identify the roles that writing and narrative can play in medical education, patient and self-care, and/or professional development schemes.

Bringing together psychologists, psychiatrists, interdisciplinary professionals, GPs, service users, and historians of literature and medicine, we will be asking questions about literature as a point of therapeutic engagement. We will explore methods that can be used to increase the well-being and communication skills of healthcare providers, patients and family members.

Conference Coordinator:

Victoria Sewell (UCD)

child.psychiatry@ucd.ie

Book HERE with UCD 

Full Programme

The Cost of Insanity by Alice Mauger

The Cost of Insanity: Public, Voluntary and Private Asylum Care in Nineteenth-Century Ireland

How did Irish medical practitioners and lay people interpret and define mental illness? What behaviours were considered so out of the ordinary that they warranted locking up, in some cases never to return to society? Did exhibiting behaviour that threatened land and property interests, the financial success of the family or even just that which caused embarrassment eclipse familial devotion and render some individuals 'unmanageable'? These questions are addressed in this month's post by Dr Alice Mauger. In 2014, Alice successfully completed her doctoral thesis at the UCD Centre for the History of Medicine in Ireland on domestic and institutional provision for the non-pauper insane in Ireland during the nineteenth century.

The Evolution of Asylum Care

Paying patients in the Richmond District Asylum (1885-1900).
Pictures courtesy of the Grangegorman Community Museum

The nineteenth century saw the evolution of asylum care in Ireland. While Jonathan Swift famously left most of his fortune to found Ireland's first lunatic asylum in 1746, it would be 70 years before the government followed his lead. In 1817 it enacted legislation permitting districts throughout Ireland to form asylums and by 1900, twenty-two such hospitals accommodated almost 16,000 patients. Growing demand for care for other social groups prompted the decision, in 1870, to admit some fee-paying patients, charged between £6 and £24 per annum, depending on their means. Out of this 16,000 only around 3% actually paid for their care. Private asylums, meanwhile, charged extremely high fees that were out of reach for the majority of society (usually several hundred pounds per year) and by 1900, thirteen private asylums housed 300 patients. Occupying a sort of middle ground, voluntary asylums, established by philanthropists, offered less expensive accommodation to those who could not afford high private asylum fees (from around £24 to a few hundred pounds). By 1900, these four voluntary asylum had outstripped the thirteen private ones, providing for 400 patients.

The Road to Committal

Advertisement for Farnham House, Private Asylum and
Hospital for the Insane, Finglas Dublin.
Source: Medical Directory (London, 1899), p. 1616.

Families were usually responsible for determining when it was time to commit a patient, where to send them and how much they should pay for their care. Factors such as cost, spending power, standard of accommodation, a hospital's religious ethos and the sort of people confined there all coloured these decisions. Broadly speaking, certain social groups (of the same religion) chose certain asylums.

Once admitted, patients were assessed by the medical authorities who determined a cause for their illness along with a diagnosis. This process was based on the medical certificate obtained prior to committal; evidence supplied by the patient and family; and the medical practitioner's own views. The two primary nineteenth-century diagnoses – mania and melancholia – reveal relatively little about reasons for committal. The causes named, however, were far more colourful and wide-ranging and expose much about contemporary perceptions of the life events or circumstances that led to mental illness and therefore committal. Given causes encompassed a range of 'psychological' factors such as grief, bereavement, business or money anxieties and religion, and physical influences including accidents and injuries, physical illnesses, hereditary and alcohol. These later two were the most frequently employed, demonstrating widespread medical understandings of the physical nature of insanity. However, many patients, families and increasingly asylum doctors, reported that fears about financial stability, land interests and the state of the economy had caused the illness.¹ In reality, it was often these anxieties that resulted in committal, especially among those with a degree of resources, such as white-collar workers, shopkeepers and farmers.

The Case of John D

Entries in Casebook 2, c.1898.
Source: St John of God's Hospital,
Patient Records.

Land and property interests certainly featured in the case of John D. In 1891, at the age of 77, John was committed to the Enniscorthy lunatic asylum by this two sons. John's sons provided details of his personal history to the asylum authorities; details which were later transcribed by the asylum's Resident Medical Superintendent, Dr Thomas Drapes, into his case notes. Reportedly a 'healthy old man', the first symptom noticed by John's sons was that he wanted to marry his servant, a girl of twenty:

Says if he doesn't marry her his soul is lost and that he'll burn in hell ... he is very supple and has often tried to take away across the country to get to this girl ... Son says he won't allow bedclothes to be changed or bed made since the girl left, as he says no one can make it but her.²

While John was a patient in the asylum, this girl visited him disguised as his niece. Following this, John's sons told Drapes to prevent any further communication between the pair. They were very much against the proposed marriage, insisting that 'she and her family are a designing lot' and 'all encourage her to get him to marry her'. One son informed Drapes that in his opinion his father would have married '"anything in petticoats" for past two years or so'. Allegedly, the girls he proposed to were 'not at all suitable, and "strealish" in appearance and habits'.

Underlying this narrative were anxieties about John's property. A farmer and a shopkeeper, John was certainly not a pauper. His maintenance in the asylum was £18 per annum and while he was in the asylum, John presented Drapes with a further £16 'to keep for him'. The sons made clear their anxieties about the family business. On one visit they stated that lately, their father 'was not capable of properly doing business in his shop'.

The real motivation for committing John, however, became clear when the patient later informed Drapes that 'he gave his sons up his land, but wished to retain his shop for himself and get a wife to mind it for him'. John also gave what Drapes termed a 'rational explanation' for his romance with the servant girl, explaining that:

the girl had been so spoken of in connection with him that her character had suffered, and that if he did not make her the only reparation he could by marrying her, he would suffer in the next world.³

Just two months after his committal Drapes discharged John. In his notes he wrote that this was 'greatly against the wishes of his sons, but I have not been able to find any distinct evidence of his insanity'.⁴ By 1901, John, now aged 87, had married a woman of 27, possibly the servant girl. However, ten years later, it was his son who resided at this address with his own wife and six children suggesting that he had ultimately inherited the property.⁵ The most plausible explanation for this outcome was that John's young wife had not borne him any children, which would have prevented her from being entitled to property rights following his death.

Conclusions

The case of John D adheres comfortably both to contemporary public hysteria over the perceived vulnerability of private patients to wrongful confinement and commonly held representations of the rural Irish.⁶ Although some historians have emphasised the detrimental impact of issues such as the consolidation of landholdings, emigration, land hunger and Famine memories on emotional familial bonds, historians of psychiatry have identified the 'range of familial emotional contexts' which asylum patients came from.⁷ Families often sent letters querying treatment, offering advice and enclosing food and money for patients.⁸

Yet, in cases where property or business interests were at stake, these factors tended to eclipse those of familial devotion. In fact, the high numbers of fee-paying patients who were unable to control their business or function in their profession suggests this was a major reason for committal. While the extent to which John D actually struggled in his shop is difficult to ascertain, it is conceivable that a number of other relatives' claims regarding patients' incapacity to work were genuine.

The association between working life and mental illness speaks volumes about contemporary society's interpretation of insanity and what drove families to commit relatives to asylums. In relation to social status, those unable to maintain their position within their given occupation were defined in terms of this failure. Land disputes and an inability to manage one's affairs threatened to shatter emotional familial bonds. In these cases, families may have viewed committal as a last resort in order to protect their resources or livelihood. After all, in smaller rural towns, relatives would have little control over the actions or interactions of a mentally-ill person positioned behind the shop-counter or at a farmers' market.

Dr Alice Mauger

Dr Alice Mauger was awarded a PhD by University College Dublin in 2014 for her thesis which examined institutions for the non-pauper insane in nineteenth-century Ireland. Prior to this she completed the MA programme on the Social and Cultural History of Medicine at the UCD Centre for the History of Medicine in Ireland, UCD. Both her MA and PhD were funded by the Wellcome Trust. Dr Mauger has published on the history of psychiatry in Ireland and is currently writing a monograph stemming from her doctoral research.

Below you can listen to Alice's talk, entitled 'The Cost of Insanity', given on 4 February 2016 as part of the UCD Centre for the History of Medicine in Ireland Seminar Series.

---

1 Fears of poverty and unemployment among pauper asylum patients are discussed by: Akihito Suzuki, 'Lunacy and labouring men: narratives of male vulnerability in mid-Victorian London' in Roberta Bivins and John V. Pickstone (eds), Medicine, Madness and Social History: Essays in Honour of Roy Porter (Basingstoke, 2007), p. 118; and, Catherine Cox, Negotiating Insanity in the Southeast of Ireland, 1820-1900 (Manchester, 2012), pp 59, 121.^↩
2 Clinical Record Volume No. 3 (Wexford County Council, St Senan's Hospital, Enniscorthy, p. 264)^↩
3 Ibid.^↩
4 Ibid.^↩
5 Census of Ireland 1901.^↩
6 David Fitzpatrick, 'Marriage in post-Famine Ireland', in Art Cosgrave (ed.), Marriage in Ireland (Dublin, 1985), pp 116-31; Timothy Guinnane, The Vanishing Irish: Households, Migration, and the Rural Economy in Ireland, 1850-1914 (Princeton, 1997).^↩
7 Cox, Negotiating Insanity, pp 108-9; Guinnane, The Vanishing Irish, pp 142-43, 230-35.^↩
8 Oonagh Walsh, 'Lunatic and criminal alliances in nineteenth-century Ireland' in Peter Bartlett and David Wright (eds), Outside the Walls of the Asylum: The History of Care in the Community 1750-2000 (London and New Brunswick, 2001), p. 145.^↩

Website Launch: Exploring the History of Prisoner Health

A new website, Exploring the History of Prisoner Health - or histprisonhealth.com - has been launched by the team (co-PIs Dr Catherine Cox (CHOMI, UCD) and Professor Hilary Marland (CHM, University of Warwick)) researching the Wellcome Trust-funded project, 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850-2000'.

Policy Workshop

Exploring the History of Prisoner Health, has been launched in advance of the project's upcoming policy workshop, The Prison and Mental Health - From Confinement to Diversion, which is going to be held in the Shard, London, 12 February. The workshop itself aims  to explore the potential for historians, criminologists, NGOs, policy makers and prison service employees to share ideas and information around the theme of mental health in the prison system.

Project Themes

The website's blog details some of the main project research strands on prisoner mental illness, physical health, juvenile prisoners, political prisoners, as well as the Prison Medical Service. Content will be developed as research progresses and new strands come on board.

A Question of Authority: the Management of Shell Shock at the Irish War Hospitals during the Great War by Peter Reid

In this month's blog post Peter Reid, MLitt research student at the Centre for the History of Medicine in Ireland (CHOMI), UCD, looks at the treatment of shell shock in Ireland during the Great War. He argues that the formation of a rational medical service for these soldiers in Ireland was undermined by the antagonistic relationship between military and civilian medical authorities.

Queen Street, Dublin.
Image provided courtesy of Peter Holder,
Irish Historical Picture Company

On 22 July 1929, John Kelly, an ex-British soldier, fell from a window of his residence in Dublin's Queen Street and later died from his injuries while being treated at the Richmond Hospital. His wife did not witness his fatal fall, but said that her husband, 'had been in ill-health since his discharge from the army in 1919, suffering from paralysis and shell shock.¹

Until recently, there had been relatively little research undertaken on the management of shell shock in Irish institutions during the Great War. In the case of Britain, Peter Leese has shown that army and military concerns dominated over those of civilian medical experts.² This post argues that a similarly asymmetrical relationship between asylum and military medical personnel was one of the key factors inhibiting the development of a well-coordinated shell shock treatment system in Ireland.

The Irish War Hospitals

The Richmond War Hospital, 1916-1919.
Image provided courtesy of the
National Archives of Ireland.

In Britain, by 1916, demand had overwhelmed the capacity of treatment facilities for shell shocked soldiers. From the summer of that year, the first treatment centres in Ireland, which would include two war hospitals, began to open in the main urban centres of Dublin and Belfast. The first of the war hospitals, a thirty-two bed unit, the Richmond War Hospital, received its first patients in June 1916. This hospital was a separate block within the grounds of Dublin's Richmond District Lunatic Asylum, allocated by the asylum's board of governance for this purpose. It admitted only British Expeditionary Force soldiers, that is, those soldiers who had served overseas at the Western Front. The main Richmond Asylum itself, however, admitted non-British Expeditionary Forces - the home troops. The army paid a generous stipend to the Richmond Asylum for the care of both categories of soldier.

Belfast District Lunatic Asylum.
Image provided courtesy of the National Library of Ireland.

In response to rising casualty numbers, the civil and military authorities agreed to relocate existing patients from the Belfast District Lunatic Asylum and use that facility as another war hospital. The Belfast War Hospital opened in May 1917 under the management of the existing District Lunatic Asylum Committee. It provided 500 beds for the use of both expeditionary and non-expeditionary British service personnel. Dr William Graham, the Medical Superintendent of the Belfast Asylum, remained in place as the medical authority running the new war hospital.

The evidence suggests that Dr William R. Dawson, already a leading figure in Irish medicine and highly regarded by the British army, played a key role in facilitating, if not initiating, both arrangements.

William R. Dawson, appointed by the War Office in 1915,
as a specialist in nerve disease to treat British service personnel in Ireland.
Image provided courtesy of the Royal College of Physicians of Ireland.

The Resident Medical Superintendents and the Royal Army Medical Corp

King George V Hospital, built 1902
(St Bricin's Military Hospital), Arbour Hill, Dublin.
Image courtesy of the National Library of Ireland.

Tensions in the relationship between the Richmond Asylum's Medical Superintendent, Dr John O'Conor Donelan, and his military counterpart, Lieutenant Colonel Hearn, Officer in Charge, George V Hospital, Central Military Hospital Dublin, quickly became apparent. Hearn instructed Donelan by letter that as Officer in Charge of Central Hospital that he, Hearn, was ultimately responsible for all soldiers in the asylum, 'until such time as they are invalided out of the army'.³ Three days later, Hearn again wrote to Donelan and firmly reiterated the point that 'should a man in your opinion require to be moved to the General Asylum [from the Richmond War Hospital] he still remains a soldier until finally discharged from the service by recommendation of the Military Board'.⁴ 

Dr John O'Connor Donelan, Resident Medical Superintendent,
Richmond District Lunatic Asylum, Dublin.
Image by kind permission of Dr Aidan G. Collins,
St. Vincent's Hospital, Fairview, Dublin 3.

The army's insistence on reserving the use of the war hospital solely for expeditionary soldiers, on prioritising their treatment over that of non-expeditionary soldiers, on maintaining their control over the admission and discharge of all military patients, and the complex bureaucratic needs of the military machine, served to insidiously undermine Donelan's authority. Donelan's dissatisfaction with the arrangement is evident in his asylum report of 1917 when he bemoaned the high number of discharges 'classified as only relieved'. He attributed this to 'the fact that a considerable proportion of these were soldiers under temporary treatment, who were removed by the Military Authorities to other asylums before recovery'.⁵ Donelan was implicitly criticising the military authorities for prioritising the needs of the army over the professional opinion of asylum medical officers, in particular himself.

When the Belfast War Hospital opened in May 1917, it was initially managed by the existing District Lunatic Asylum Committee. However, as Lieutenant Colonel J.B. Buchanan, Officer-in-Charge of Holywood Military Hospital, noted in 1919, 'this plan did not prove satisfactory'. When the Resident Medical Superintendent, Dr William Graham, died suddenly in November 1917, the Belfast War Hospital came under the direct control of the War Office.⁶

Consequences of an unsatisfactory relationship

Between 1916 and 1919, the Dublin and Belfast Irish war hospitals treated 1,577 soldiers. However, there were never enough beds in Ireland for emotionally traumatised soldiers such as John Kelly and, by 1921, the 'South Ireland Pension Area' - Ireland exclusive of the province of Ulster - had the longest waiting list in Britain and Ireland for treatment.⁷ The antagonistic relationship between medical and military actors was one factor contributing to this unfortunate situation.

Contemporary relevance

In a report issued in July 2015, the Mental Health Commission identified that a lack of cohesion and 'deep disharmony' between clinicians and managers had undermined clinical governance in Carlow/Kilkenny and South Tipperary and, in early 2014, was associated with a 'spike' in suicides in the region.⁸ This reflects the continuing importance not only of independent surveillance by bodies such as the Mental Health Commission and the Health Information and Quality Authority, but also of managerial and clinical relationships in the delivery of contemporary mental health services in Ireland.

Peter Reid completed a MA in the Social and Cultural History of Medicine at the Centre for the History of Medicine in Ireland (CHOMI), UCD, in 2014. The title of his MA dissertation was, 'The Institutional Management of Soldiers with Shell Shock in Ireland, 1916-19'. In September 2015, Peter will be commencing a MLitt at CHOMI, investigating the treatment of children with disability in early twentieth-century Ireland.

---

1 Irish Times, 24 July 1929.^↩
2 Peter Leese, Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War (Basingstoke and New York, 2002), 54-6, 98.^↩
3 Letter to Resident Medical Superintendent, Richmond Lunatic Asylum from Lieutenant Colonel Hearn, King George Fifth Hospital, 1 August 1916, Richmond War Hospital Admission and Discharge Book, BR/Priv 1223, NAI.^↩
4 Hearn to Resident Medical Superintendent, Richmond Lunatic Asylum, 4 August 1916.^↩
5 Richmond Asylum Joint Committee Minutes, 1917, 17, BR/Priv 1223, NAI.^↩
6 Medical History of the War: Report in Compliance with War Office Letter No. 24/General Number/6978 (A.M.D.2) 18 October 1919, WO 35/179.^↩
7 Joanna Burke, 'Effeminacy, ethnicity and the end of trauma: the suffering of "shell-shocked" men in Great Britain and Ireland, 1914-39, Journal of Contemporary History, 35, no. 1 (2000), 69.^↩
8 Irish Times, 22 July 2015.^↩

Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000

Prisoner Health Project: Wellcome Trust Senior Investigator Award

histprisonhealth.com

A major new research project in the history medicine has just been launched: 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000'. This collaborative, five-year study, funded by a Wellcome Trust Senior Investigator Award, is being led by co-Principal Investigators, Professor Hilary Marland, of the Centre for the History of Medicine, University of Warwick, and Dr. Catherine Cox, Director of the Centre for the History of Medicine in Ireland, University College Dublin.

Strangely, the history of medicine, despite its strong focus on the history of institutions, has neglected the prison as a site of medical treatment. It's great to see that such an ambitious project is going to address this omission. That this is a comparative research project is also exciting; comparative historical analysis, despite its strong tradition in the social sciences and a limited recent resurgence, is long overdue a renewal.

Project aims

The co-Principal Investigators, Catherine and Hilary, are keen for the project's research to resonate with contemporary concerns in the prison service and they aim to tackle historical questions of prisoner health that are still relevant today. For example, they and their team are going to look at the high incidence of mental illness amongst prisoners, the health of women prisoners and the status of prison maternity services, as well as the response to prisoner substance abuse and the impact of HIV/AIDS. All of these topics are still major concerns in the medical management of contemporary prison populations in Ireland and England. 

Late nineteenth-century photographs of
prisoners in Reading Gaol
Berkshire Records Office P/RP1/5/2
Source: Berkshire Family Historian

Scope of project

Each of the different research strands within the project will cover the period from rise of the modern penal system during the mid-nineteenth century up to the present. Fundamental to the project is the comparative analysis of English and Irish prison services and the conceptual basis of prisoners' entitlement to health in both England and Ireland. 

Prisoner health and human rights

The project team is going to address the question of who advocates for prisoners' health, both within and without the prison service. They will also investigate the extent to which prisoners have been seen as entitled to health care and if human rights debates have had any influence on the provision of medical care for prisoners. Another principal area of historical inquiry is going to be the extent to which prison doctors have felt themselves to be constrained by dual and conflicting loyalties to the prison regime and to their prisoner patients. 

Policy workshops and public engagement

Hilary and Catherine have also said that the project is going to engage with policy makers and prison reform organisations, including the Howard League for Penal Reform. With that in mind, they are busily preparing several policy workshops and compiling a list of potential invitees. They also hope to engage with the general public and people working in the area of prisoner welfare through a series of outreach projects. Among the most interesting of these are their plans to commission both a theatrical production and a piece of artwork that will be based on their team's research findings. 

Project members

Dr. Catherine Cox, University College Dublin, Principal Investigator. 

Professor Hilary Marland, University of Warwick, Principal Investigator.

Both Hilary and Catherine are working on the relationship between the prison system and mental illness – a subject of acute contemporary relevance considering the high levels psychiatric morbidity amongst prisoners – and they are also looking at the impact of the prison on prisoner mental health. In addition, Catherine will focus on the evolution of the separate system in Ireland and its impact on mental health while Hilary will examine the question of women and mental health in the prison system.

Dr. Will Murphy, Mater Dei Institute, Dublin City University, is researching the health of political prisoners and the impact they had in shaping attitudes and practices of health and medicine in Irish and English prisons.

Dr. Fiachra Byrne, University College Dublin, Postdoctoral Research Fellow (3 years), is working on the mental health of juvenile prisoners in England and Ireland.

Dr. Nicholas Duvall, University of Warwick (year 1), University College Dublin (year 2), Postdoctoral Fellow (2 years), is going to be supporting Hilary and Catherine in their research and will also develop his own project on the health of prison officers. 

Dr. Margaret Charleroy, University of Warwick, Postdoctoral Research Fellow (3 years), is working on the management of prisoner health, disease and chronic illness.

A further Postdoctoral Fellow, who will be researching the history of HIV/AIDS in prisons under the supervision of Professor Virginia Berridge at the London School of Hygiene and Tropical Medicine is slated for appointment later this year (2015).  

Public Engagement Officers, at Warwick and Dublin, will be appointed in late 2015. They will have responsibility with implementing the project's arts and policy initiatives.

In 2016, there will be two PhDs appointed to the project. One, based at UCD, will work on prison reform movements; the other, based at Warwick, will investigate the health of women prisoners.

If you want to find out more about 'Prisoners, Medical Care and Entitlement to Health in England and Ireland, 1850–2000', you can visit the UCD project page or the Warwick project page. The project team have also announced their Advisory Board members and provide a list of recent and upcoming project activities.

For further project details or inquiries, you can contact Hilary by email at hilary.marland@warwick.ac.uk or Catherine at catherine.cox@ucd.ie

The historical development of Irish Hospitals and the importance of their records by Brian Donnelly

In this month's post, Brian Donnelly, senior archivist at the National Archives of Ireland, outlines the development of Irish hospitals from the eighteenth to the twentieth century.

Rotunda Hospital, Dublin
(RCPI Archival collections: VM/1/4/19)

The establishment of the voluntary hospitals

The early eighteenth century saw the establishment of voluntary hospitals by philanthropists, mainly in Dublin but also in the larger provincial towns. Jervis Street hospital (the Charitable Infirmary) was the first voluntary hospital Ireland and was founded in 1718.  Many of these, like Dr. Steeven’s Hospital (founded in 1733) and Mercer’s (founded 1734) would survive into the twentieth century.  The eighteenth century also saw the establishment of specialist hospitals, most of them voluntary, such as the Rotunda Lying In Hospital, founded in 1745, St. Patrick’s Hospital for mental illness, founded in 1747 and the Westmoreland Lock Hospital, for the treatment of venereal disease, in 1792. 

A modern public health service at county level began in 1765 when a parliamentary enactment provided for the erection and support of an infirmary for each county in Ireland and also permitted support for several existing hospitals, mainly in Dublin and Cork, out of public funds.  The county infirmaries were to be maintained by grand jury presentments, parliamentary grants and local subscriptions. The grand juries were groups of landowners who were called together by the High Sheriff in each county twice a year for legal and local administrative reasons.

The House of Industry hospitals, district lunatic asylums and medical dispensaries

The Dublin house of industry, a precursor of the workhouses of the nineteenth century, was founded in 1772. This institution became in time a vast concern, providing hospitals for the sick, an asylum for children, bridewells, penitentiaries for women and young criminals, a house of industry for vagrants, and cells for lunatics.  From it evolved the House of Industry hospitals – the Richmond, Whitworth and Hardwicke - and it played a major role in establishing the first and largest of the public lunatic asylums – the Richmond Lunatic Asylum – which opened for patients in 1814. Following the report of the Committee on the Lunatic Poor in 1817, the Lord Lieutenant was enabled by statute to build asylums where he considered necessary and, over the next half century, a well-developed mental health infrastructure was in place. By 1871, twenty two asylums were being financially supported by the grand juries. In 1850 a central asylum “for insane persons charged with offences in Ireland” was opened in Dundrum. This institution, the first criminal lunatic asylum in these islands, was under the direct control of the Lord Lieutenant who appointed the staff and made regulations for its management. 

A few dispensaries were supported by voluntary subscriptions in several of the larger towns and cities from the late eighteenth century, but it was not until 1805 that grand juries were authorised to give grants to dispensaries in rural areas. By the early 1830s, there were 450 dispensaries throughout the country, administered by committees of management and supported partly by subscriptions and partly by grand jury grants. There were fewer dispensaries in poorer areas, where voluntary contributions were wanting, and where it was difficult to raise enough money to start them. Inadequate as many of these dispensaries were, they represented the first steps towards domiciliary medical treatment of the rural population.

Robert Graves (1796-1853)
 (RCPI Archival collections: VM/1/2/S/35)

The impact of epidemics on the development of medical infrastructure

Epidemic disease was a major impetus in the development of a medical infrastructure. Typhus was a major scourge in Ireland in the early nineteenth century and, while several fever hospitals had been established in the larger towns in the late eighteenth century, it was not until 1807 that legislation was passed to encourage their construction throughout the country. A fever epidemic of unprecedented proportions raged in Ireland between 1816 and 1819. Under an 1818 Act, local boards of health could be established, supported partly by grand juries, which had extensive powers to combat disease. Grand juries were empowered to make presentments equal to twice the amount raised by private subscription to build fever hospitals. In 1819, legislation enabled officers of health to be appointed in parishes and a parish health tax could be levied. 

The establishment of the Central Board of Health in 1820 marked a major step in the centralisation of medical relief and local boards of health were to play a major role in combating epidemics over the following decades. The Central Board of Health collected statistics about local health conditions, advised where local boards of health should be established and when grant to hospitals should be made. When cholera broke out in Ireland in March 1832, the Central Board of Health, renamed the Cholera Board for the duration of the epidemic, supervised measures to combat the disease which included the establishment of local boards of health. 

Dublin hospitals like the Meath were at the forefront of the fight against infectious disease from the 1820s and introduced new methods of bedside clinical training to the English speaking world.  The census commissioners noted in 1854 that to these metropolitan hospitals “the Irish School of Medicine is largely indebted for the celebrity which it has so long enjoyed”. The Meath hospital received international recognition in the early nineteenth century due to the innovative teaching methods and research carried out by its physicians, Robert Graves and William Stokes. The latter had survived an attack of typhus in 1827 and identified the first case of cholera in Ireland in 1832. This new approach to clinical training had originated on the continent and its introduction into the Meath hospital heralded what has been described as the heroic age of the Irish School of Medicine. The voluntary hospital infrastructure continued to expand during the nineteenth century and following Catholic Emancipation many Catholic religious orders became involved in founding hospitals.

The Irish Poor Law, 1838

The enactment of the Irish Poor Law of 1838 was to have a dramatic effect on the provision of public health services for the rest of the nineteenth century. The country was divided into over one hundred and fifty poor law unions each with a workhouse at its centre and administered by a board of guardians.The structure of the poor law system, being modern and efficient and more easily subject to central control, was adapted on nearly all occasions where a new local function was created or an old one modified .The Medical Charities Act of 1851 led to the modernisation and extension of the old grand jury dispensary network under the boards of guardians and made a domiciliary medical service available to large sections of the population, the destitute poor, for the first time. 

By 1852, every poor law union had been divided into a number of dispensary districts, each with a dispensary and medical officer.  Patients had to apply to a poor law guardian for a ticket every time they wanted to attend a dispensary free of charge. Committees of management were responsible to the boards of guardians for the management of the dispensaries and appointing the dispensary doctors. In 1863, the dispensary doctors were made registrars of births and deaths and of Roman Catholic marriages and the practice of registering births, marriages and deaths was standardised on the 1^st of January 1864. When registering deaths, the dispensary doctors were required to note the cause of death and duration of illness, thus enabling accurate statistics of mortality to be compiled for the first time. The registration of births enabled such measures as the compulsory vaccination of children against smallpox to be carried out effectively and by the end of the nineteenth century this scourge had, to a great extent, been eliminated.

While many boards of guardians had allowed the non-destitute to enter workhouse hospitals for treatment during the 1850s, the 1862 Poor Law (Amendment) Act officially opened the workhouse hospitals to the non-destitute sick. As a result of these developments, Ireland had one of the most advanced health services in Europe in the mid-nineteenth century, if policy and structure are to be taken as criteria. The Local government (Ireland) Act, 1898, replaced the grand juries by democratically elected county and rural district councils. The county councils took over the administration, either directly or through joint committees, of the district lunatic asylums.

Newcastle Sanatorium, Wicklow.
Image courtesy of NLI (L_ROY_05467)

Tuberculosis and the sanatorium

While Ireland had a low death rate from infectious disease in the first decade of the twentieth century, tuberculosis was the marked exception. The last years of the nineteenth century saw the first attacks made against the disease with the establishment of Newcastle Sanatorium in 1893. In 1904, the sanitary authorities of County Cork combined with Cork Corporation to establish Heatherside Sanatorium near Doneraile. In 1907, the Dublin City and County authorities established Crooksling Sanatorium. A Tuberculosis Prevention Act was passed in 1908 which gave the county councils power to provide sanatoria and brought the first veterinary inspectors into the employment of the sanitary authorities.  Peamount Sanatorium was founded in 1912 through the efforts of the Women’s National Health Association, the most formidable health pressure group of the early twentieth century.

Public health provision in post-independent Ireland

The turbulent years of the early 1920s saw some revolutionary changes in the public health system. In general, the boards of guardians outside Dublin were abolished and were replaced by county boards of health and public assistance, essentially sub-committees of the county councils. Most workhouses were closed to save money and central institutions called county homes were established in each county where the poor were to be relieved. While the newly styled county homes were to be reserved in theory for the old and infirm many soon included unmarried mothers, children and the mentally retarded.  Following the establishment of the Irish Free State the Department of Local Government and Public Health formally became, in 1924, the central government authority for local government and health administration. The Minister took over the Lord Lieutenant’s duties in relation to the mental hospitals. In 1930, the establishment of the Irish Hospitals Sweepstakes, a lottery to provide financial assistance to hospitals, provided a financial lifeline to many voluntary hospitals who were struggling to survive following a reduction in the number of endowments and bequests after the Great War.

The post-war period and declining mortality

There were significant developments in health care in the 1940s and 1950s. The Mental Health Treatment Act of 1945 modernised the legal code under which the mental services operated and provided important safeguards against the arbitrary detention of patients although the numbers of persons being treated continued to increase until, by 1959, there were 20,000 patients in Irish mental hospitals.  In the years immediately after 1945 there was a major effort to develop anti-tuberculosis services. The Tuberculosis (Establishment of Sanitoria) Act of 1945 permitted the Minister for Local Government and Public Health to arrange for the building of sanatoria and to transfer these to local authorities when completed. This was a major departure from established practice for the central authority as it stepped outside its normal functions of directing and co-ordinating the local services. Sanatoria were built at Dublin, Cork and Galway and were handed over when completed to the local authorities as was provided under the Act. 

There was also widespread building and conversion of buildings for the treatment of tuberculosis cases by local authorities.  These developments, together with the payment of maintenance allowances for dependents of persons undergoing treatment for infectious disease, mass radiography, BCG vaccination and new drugs such as streptomycin, led to a great decline in mortality for the disease and in the number of new cases appearing.  In 1947 the Department of Local Government and Public Health was divided into two separate departments. The Health Act of 1953 extended eligibility for general hospital services and maternity care to a much wider class. Health authorities were now required to provide child welfare clinic services and the school health service was improved. The dispensary service and dispensary doctors were transferred from the public assistance code to the health authorities. The old dispensary ticket system was done away with and replaced by medical cards. A more liberal code for the governing of county homes was introduced and provision was made for the development of a comprehensive rehabilitation service.

William Stokes (1804-78) and William Wilde (1815-76)
(RCPI Archival Collections: PDH/6/2/12)

1970s regionalisation and the Irish 'love affair' with the hospital bed

By the 1960s, it was felt that as the state had taken over the major financial interest in the health service there should be a new administrative framework combining national and local interests.  For technical and logistical reasons it was believed that better services could be provided on a regional rather than a county basis.  The establishment of the health boards under the Health Act, 1970, marked a major break in the link between the health services and county administration. At this time Ireland had the highest proportion of hospital beds to population in western Europe and the Irish hospital system was described as “one of a large number of small institutions scattered throughout the country”. The following decades would see the closure or amalgamation of many voluntary and state hospitals into larger units and the dismantling of the old mental hospital infrastructure.

The historical value of Irish hospital records

That Irish hospital records are of great historical interest has long been acknowledged. Dr. William Wilde, the internationally renowned nineteenth century physician and statistician, recognised one hundred and seventy years ago that the hospital registers of the Rotunda Hospital represented the ‘most interesting and earliest statistical tables on record’.  Ireland’s medical institutions, both voluntary and public, have a peculiarly rich and varied history and have played a paramount role in medical advances over the last three centuries.  While some collections of hospital archives are now safe in archival custody, many collections remain in peril. These archives have no protection under the law and it is often only through the good offices of interested hospital staff that material has been preserved. 

Brian Donnelly is a Senior Archivist at the National Archives with responsibility for Business and Hospital records. Images courtesy of Fergus Brády, Archivist, RCPI. 

A Malady of Migration: theatre production in Coventry and Dublin

At a time when the issues of migration and mental health are seldom out of the news, the Centre for the History of Medicine in Ireland (CHOMI) has worked with the Centre for the History of Medicine at the University of Warwick (CHM) and Talking Birds theatre company to develop a new theatre production which explores why the mid-nineteenth century saw a prevalence of mental disorders among Irish migrants.The new piece is called 'A Malady of Migration' and is based on research being carried out by Professor Hilary Marland of Warwick and Dr Catherine Cox of University College Dublin, in a project called Madness, Migration and the Irish in Lancashire, c.1850-1921, funded by the Wellcome Trust. They are supported by postgraduate students and others, who will conduct supplementary research and take supporting roles in the drama.

There will be an expert panel discussion after the Thursday evening performances in each venue and a post performance discussion on Saturday lunchtime, providing opportunities for audience members to discuss the making of the piece with researchers and the theatre company, and to engage in debate on issues raised by the performances. A series of short briefing sheets have been produced to complement the drama and provide background information. These can be accessed here.

Check out the Malady of Migration website here!

Performances

Shop Front Theatre, City Arcade, Coventry CV1 3HW (opposite Argos):
Thurs 26th to Sat 28th June 2014
1pm - £6 (£3) and 7pm - £8 (£4)
Box office 0845 680 1926 talkingbirds.co.uk

The New Theatre, Temple Bar, Dublin:
Thurs 3rd to Sat 5th July 2014
1pm - €8 (€4) and 7.30pm - €10 (€5)
Box office 01 670 3361 thenewtheatre.com

A Malady of Migration

Madness, migration, and the Irish in Lancashire, 1850-1921

‘[S]he is in a highly hysterical state. She’s a woman who resists’: the Dangers of Spiritualism in J. S. Le Fanu’s All in the Dark (1866) by Valeria Cavalli

In this month's post, Dr Valeria Cavalli examines the  theme of spiritualism in Irish writer Joseph Sheridan Le Fanu's novel All in the Dark (1866), and what the author's warnings about the dangers of spiritualism tell us about Victorian attitudes to women and madness. 

The dangerous habit of practising séances

When William Maubray is called to his dear aunt Dinah’s deathbed, he hopes that he will get there in time to say goodbye. He is certainly surprised, then, to find her in quite good shape, if not for her firm conviction that she is going to die before midnight. Dr. Drake explains to the puzzled young man that his aunt suffers from nothing more serious than the ailments of a woman of her age, but that she has recently fallen victim of self-deception. The eccentric old woman has in fact taken up the dangerous habit of practising séances, and the risk is that she will drive herself mad if she insists in taking seriously the ominous revelations of her spirit friend. Written in the peak years of Spiritualism, Joseph Sheridan Le Fanu’s All in the Dark brings forth a way more terrifying reality than being haunted by ghosts, that is, being locked away in a lunatic asylum on the basis of one’s unorthodox creed.

The rise of spiritualism

Emerging in America in the late 1840s, Spiritualism spread almost immediately to Europe, finding fertile terrain in the state of religious uncertainty which was troubling part of the population, regardless of class, age, or gender. When scientific discoveries brought the credibility of the Bible into question, believers began to feel uneasy with the way Christianity explained the supernatural, and began to look for comfort in the occult. In fact, the occult could account for the supernatural according to the laws of nature: whatever forces were inexplicably ruling the Universe or man, they were completely natural, and their present state, if still unknown to science, was open to investigation. However, scientists and members of the Church together raised their voices in opposition to the movement from its very first appearance, and criticism poured from the pages of periodicals and newspapers.

Joseph Sheridan Le Fanu. 

Image from: www.swanriverpress.ie/lefanu200,

Spiritualism and female transgression

As Alex Owen has pointed out in her Darkened Room (1989), many medical men regarded the movement with distaste and suspicion in part because of the increasing role it offered to women. In those years, the ideal woman was the submissive wife and mother, “the angel in the house” in charge of the domestic sphere. In giving women the authority and the right to exercise their innate spiritual powers, Spiritualism infringed on the culturally imposed limits of respectable womanhood. In the darkened room, not only did women become the principal actors of the séance, they also transgressed gender norms, by assuming male roles or highly sexualised trance personae. The subversiveness of the movement alarmed and alerted the medical profession, which was in charge of policing any deviations from the social order imposed by Victorian patriarchy. The emerging medical branches of psychiatry and gynaecology effectively teamed up to prove that women’s health depended on female biology. Since women’s role was primarily that of generator, physical and intellectual activities would compromise the balance of nerve force necessary for the functioning of the reproductive organs, thus causing mental instability. Most cases of insanity due to sexual illness tended to result in monomanias, among which Spiritualism was counted, and doctors began to consider any kind of suspension of everyday consciousness suspicious and to associate mediumistic trance, with its uncontrollable convulsions and frequent use of inappropriate language, with the pathological symptoms of hysteria.

'Queer fancies'

In All in the Dark, Dinah Perfect is depicted as a strong-willed, authoritative, and eccentric woman. Her faithful servant explains that Dinah has always been very extravagant, with her odd dispositions concerning her corpse and coffin:

She was very particular, […] and would have her way; […] she had her coffin in the house this seven years – nigh eight a’most – upright in the little press by the left of the bed, in her room – the cupboard like in the wall. Dearie me! ’twas an odd fancy, […] and she’d dust it, and take it out, she would wi’ the door locked, her and me, once a month. She had a deal o’them queer fancies, she had. [II, pp.168-9]

'She is in a highly hysterical state'

It is no surprise, then, that when the novelty of table-rapping reaches the Old World, it appeals mightily to a housebound, bored, middle-class spinster like Dinah, who is looking for excitement and escapism from the monotony of everyday life, and from the increasing fear of ageing and dying. However, Dinah’s credulity is quickly associated with hysteria. Echoing Dr William Carpenter’s theory on unconscious cerebration, the non-believing, sceptical (and alcoholic) Dr Drake describes the dangerous effects that Spiritualism could have on Dinah’s mind, by convincing her of the reality of her delusions to the point that her body comes to provoke the effects that she expects to happen. Dr Drake is afraid that Dinah will ‘frighten herself out of her wits’, and explains to William that Spiritualism can affect the nerves [I, p. 60]:

Why, you know what hysteria is. Well, she is in a highly hysterical state. She’s a woman who resists; it would be safer, you see, if she gave way and cried a bit now and then, when nature prompts, but she won’t, except under awful high pressure, and then it might be serious; those things sometimes run oft’ into fits. [I, pp. 38-9]

 

Wrongful confinement

 

At a time when the advances in the realm of the mind became increasingly associated with scandals related to wrongful confinement, Le Fanu questions the power held by Victorian psychiatry over extravagant and independent women. Dinah Perfect is certainly a bizarre character, with her many fancies and her addiction to table-turning. However, her oddities do not seem sufficient to diagnose her as incipiently insane. Dinah is an elderly woman troubled by the frightening thought of upcoming death. Her anxiety and hysterical crises echo the spiritual uncertainty that afflicted the author’s sister and wife, like many other Victorians. Moreover, her uneasy shifting between her family’s orthodox Christianity and the occult is reminiscent of Le Fanu’s own crisis of faith, which led him to find comfort in the doctrine of the Scandinavian mystic Emanuel Swedenborg.

 Le Fanu's wife Susanna (née Bennett), and his sister Catherine. All three experienced a crisis of faith at some point in their lives. The images of Susanna and Catherine appear in W. J. McCormack’s biography of Le Fanu.

'That foolish spirit-rapping'

Having experienced first hand the anxiety of spiritual doubt, Le Fanu is far from labelling Dinah mad, even though he does not sympathise with Spiritualism. In fact, all throughout the novel, Dinah sounds reasonable and practical, advising her ward on the importance of a good match in marriage, and her nephew on the more advantageous prospect of the Church rather than the Bar as a profession. Even on spiritual matters, the Rector confirms that, ‘I found her views […] all very sound; indeed, if it had not been for that foolish spirit-rapping, which led her away – that is, confused her – I don’t think there was anything in her opinions to which exception could have been taken’ [II, pp. 171-2]. On all subjects but Spiritualism, Dinah is perfectly sound. However, her fancy for table-turning would, for orthodox Victorian psychiatry, be a strong enough proof of her insanity, as the real case of Louisa Nottidge had shown.

Louisa Nottidge

Like Dinah Perfect, Louisa Nottidge was a wealthy middle-aged spinster who had also spent money ‘very wildly’ upon the word of a Spiritualist [I, p. 8]. In 1846, Nottidge decided to leave her mother’s home to follow the influential millenarian prophet Henry Prince. Prince was the founder of a small community in Somerset called the Agapemone (the Abode of Love), where he taught about free love and preached of everlasting life to a group of devotees who had agreed to donate all their wealth to the congregation. Three of the five Nottidge sisters had already joined the prophet (who had thus gained some £18,000), so that when Louisa communicated her decision to her mother, the latter had to act quickly in order not to lose another daughter, and her considerable fortune, to an unscrupulous charlatan. Mrs Nottidge had Louisa abducted and confined to the majestic Moorcroft House private asylum at Hillingdon, in Middlesex, on the grounds of theomania. Louisa spent seventeen months at the Hillingdon, and was released only because the Commissioners in Lunacy were summoned upon concerns about her failing health. After her liberation, Louisa joined the millenarian community, transferred all her possessions to Henry Prince, and took legal action against her wrongful confinement.

A fraudulent committal

Moorcroft House private asylum at Hillington.
This picture is taken from Sarah Wise’s Inconvenient People.

The case was heard in court in 1849 before the Lord Chief Baron, the Right Hon. Sir Frederick Pollock, while the attention it received in the press provoked responses from alienists John Conolly and Forbes Benignus Winslow, and Lord Ashley, Chairman of the Commissioners in Lunacy. The Lord Chief Baron accepted Louisa Nottidge’s plea and ordered a compensation for the damages received. The suit made clear that Louisa’s admission to the Hillingdon had not been fraudulently obtained, since two doctors certified her insane on the grounds that she had ‘estranged herself from her mother’s house […] to follow a person of the name of Prince, whom she believed to be Almighty God, and herself immortal’. However, as Joshua John Schwieso has pointed out, although the two doctors had been summoned by the family physician on the basis of their ‘experience in cases of insanity’, their biographies suggest that neither of them was an expert in the field. Despite all this, the final verdict was reached because the Commission in Lunacy, in the person of Mr Mylne, failed to convince the Lord Chief Baron of the necessity of keeping Miss Nottidge confined, as shown in the following report which appeared in The Times in 1849:

The Lord Chief Baron: Mr Mylne, was this lady in such a state of mind as to be dangerous to herself or to others?   

Mr Mylne: Not so as I was aware of; not so far as I knew. 

The Lord Chief Baron: If she were not so, then how was it that you kept her in this asylum for seventeen months?

Mr Mylne: My lord, it was no part of my duty to keep her there. I was only to liberate her if I saw good and sufficient reason for adopting that course. 

The Lord Chief Baron: It is my opinion that you ought to liberate every person who is not dangerous to himself or to others. If the notion has got abroad that any person may be confined in a lunatic asylum or a madhouse who has any absurd or even mad opinion upon any religious subject, and is safe and harmless upon every other topic, I altogether and entirely differ with such an opinion; and I desire to impress that opinion with as much force as I can in the hearing of one of the commissioners. […]You say unsound mind, Mr Mylne. Had she any unsoundness of mind upon any other subject under heaven except as to entertaining these peculiar religious notions?

Mr Mylne: Miss Nottidge did not exhibit any symptoms of insanity of any other subject, my lord, that I observed.

Not only did the Lord Chief Baron support an individual’s freedom to hold religious opinions (as long as they remained harmless to both the person and other parties), he, most importantly, stated that he ‘very much doubted whether, if in this case the plaintiff had been a man, or living under the protection of a husband, the defendants would have dared to have taken the steps they had’.

An unwarranted influence

This case made evident how women, and particularly single women, were in danger of wrongful incarceration, since their unorthodox religious views (Louisa’s own mother affirmed that ‘she worships a false god’) could be easily exploited for financial gain.[ix] In fact, in the case of Louisa Nottidge, what her family were trying to save was the £5,728 7s 7d that she had bequeathed to the prophet. After her death in 1858, which occurred while she was still residing at the Agapemone, the Nottidges brought Henry Prince to court and succeeded in obtaining the return of Louisa’s property on the grounds of the prophet’s unwarranted influence upon the deceased. Thus, in the early 1860s, the case of Louisa Nottidge received new attention in the press, both in England and in Ireland, and was associated with the increasing number of cases of wrongful confinement which were causing much sensation, both in real life and in fiction.

Spiritualism and madness

           

In All in the Dark, Dinah, unlike Nottidge, is surrounded by relatives and friends who love her for who she is rather than for her fortune, and who will miss her dearly after her death. However, in discursively associating Spiritualism with madness, Le Fanu is reminding the reader of the existing danger that even an incompetent doctor like Drake, with no specific knowledge or experience of insanity, could actually provide enough evidence to have a woman like Dinah confined on the grounds of her unorthodox beliefs. Furthermore, he is also presenting a reflection on the double standard with which Victorian psychiatry was dealing with its patients. After Dinah dies, her sceptical nephew William also becomes ‘addicted to the supernatural’ and begins to believe that he is haunted by the spirit of his dead aunt [I, p. 58]. He suffers from nervous strain and hallucinations, and also admits that ‘I think I’m growing as mad as […] poor Aunt Dinah’ [I, p. 216, my italics]. However, no judgement is made about the possibility of his being a case of incipient insanity. William’s temporary condition is attributed to the weight of financial and sentimental concerns which, combined with the strong tea he likes to drink (a recurring theme in Le Fanu’s fiction), the heavy tobacco he likes to smoke, and the supernatural stories he likes to read, provokes nightmares and somnambulistic states. Financial problems, disappointment in love, bereavement, and hereditary disposition were all considered by Victorian psychiatry to be factors in the detection of mental insanity. The fact that such connections are ignored in William’s case seems to validate the words of the Lord Chief Baron, who doubted whether the same precautions would have been taken if the plaintiff had been a man.

      

In All in the Dark, Le Fanu touches on the topical association of alternative spiritualities with insanity. Drawing upon his personal experience as well as his professional familiarity, in his work for the national and international press, with contemporary debates on these topics, Le Fanu investigates the power game played by Victorian psychiatry over difficult citizens, women in particular. Although the novel shows Le Fanu’s contempt of Spiritualism, it nevertheless dismisses the accusations of madness levelled at the believer, thus becoming a warning to women readers.

Dr ValeriaCavalli recently completed a PhD in the School of English, Trinity College Dublin entitled 'They said she was mad: insanity in the fiction of Joseph Sheridan Le Fanu' (2014). She may be contacted at cavalliv "at" tcd "dot" ie. Details of an upcoming conference in Dublin on J.S. Le Fanu (15-16 October 2014) may be found here.

Further reading

• J. S. Le Fanu, All in the Dark, 2 Vols (London: Richard Bentley, 1866), Vol. 2, pp. 168-9.
• For a historical context on Spiritualism and Victorian medicine, see Alex Owen, The Darkened Room: Women, Power, and Spiritualism in Late Victorian England (Chicago, Ill.; London: University of Chicago Press, 2004), Ch. 6.
• On Louisa Nottidge, see Sarah Wise, Inconvenient People; Lunacy, Liberty and the Mad-Doctors in Victorian England (London: The Bodley Head, 2012), Ch. 4; Owen, pp. 151-54; and Joshua John Schwieso, ‘‘Religious Fanaticism’ and Wrongful Confinement in Victorian England: the Affair of Louisa Nottidge’, Social History of Medicine (1996), pp. 159-74.