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The Introduction sets out key themes and arguments relating to private, voluntary and public asylum care in nineteenth-century Ireland. It situates the book within exiting scholarship, providing context on Irish and British frameworks. The nine asylums selected as case studies are introduced, along with an explanation of the other sources consulted and methodology used. It includes a discussion of the difficulties in accessing the patient’s view and defining social class in Ireland. Extract: --- -

This chapter provides an overview of the developments leading up to the admission of paying patients to private, voluntary and district asylums. Focusing primarily on the reports of Ireland’s lunacy inspectors, the national press and the emerging psychiatric community, it is concerned with the debates aired at national level on how best to accommodate different social groups. It examines proposals for the establishment of separate accommodation for paying patients, negative press coverage of private asylums and the abuses identified by the lunacy inspectors, the growing social importance of Ireland’s four voluntary asylums and the implications of the eventual reception of paying patients in the district asylum system. Ultimately, this chapter argues that in the absence of a single effective solution, the result was a patchwork of public, voluntary and private accommodation, each the outcome of a set of shared convictions as to how, why and by whom the non-pauper insane should be treated.

This chapter explores the networks through which boards gathered financial information about patients and their families, their motivations for chasing fees and the inherent difficulties surrounding their negotiation and payment. Historians of psychiatry have long recognised the centrality of families in dialogues with medical and legal authorities during the certification and discharge process. As this chapter reveals, relatives were also crucial mediators in the admission and discharge of paying patients. Families in negotiations with voluntary and private asylums enjoyed comparatively greater influence as both asylum models depended heavily on patient fees. While the managing committees of voluntary asylums struggled to balance providing charity for the ‘respectable’ against attracting a wealthier clientele, private asylum proprietors made their livelihood from profits. Although voluntary asylums were not kept for profit, this chapter contends that by the later nineteenth century, many were forced into competition with private asylums. By the 1890s, this professional competition, together with the depressed economy, had come to inform their strategies for advertising and securing fees. The chapter also provides a comparative analysis of the length and outcome of stay for patients admitted to the nine asylums studied. Overall, this chapter argues that the existence of a ‘mixed economy of care’, particularly after 1870, gave rise to an institutional marketplace for the insane.

Centring on patients admitted to nine selected asylums, this chapter delineates the socio-economic background of fee-paying patients. This examination is largely quantitative and draws heavily on statistics gleaned from asylum records. It charts admissions in two phases: the first to the Bloomfield Retreat and Hampstead House between 1826 and 1867, and the second to the nine asylums studied between 1868 and 1900, and explores patients’ gender, marital status, religious denomination and former occupation. The chapter reveals that many paying patients in district asylums occupied a precarious social position just above the rank of pauper. Charitable and private asylum patients, meanwhile, were usually drawn from more affluent circumstances. Exploration of patients’ social profile is supplemented by analysis of their maintenance fees and property holdings, shedding further light on the spending power of discrete social groups. The existence of an institutional marketplace is further depicted through evidence of the socio-economic overlap of patients in the three types of asylum.

Focusing primarily on the period from 1868 to 1900, this chapter considers the extent to which the social class, gender and occupational profile of fee-paying patients influenced medical and lay identification of the causative factors of their insanity. Analysis of admissions registers is supplemented by a survey of asylum doctors’ casebooks, which cast further light on psychiatric definitions. Lay interpretations are also present in the case notes, where medical personnel recorded information supplied by families, friends and patients. In addition, correspondence written by patients’ friends and relatives provides indications of lay understandings. The chapter argues that asylum doctors in Ireland often constructed gender- as well as class-specific aetiologies for their non-pauper patients: primarily work for men and domesticity for women. Contrary to Britain, ‘alcohol’ was often attributed as a cause of illness, particularly among private asylum patients, reflecting cultural disparities in attitudes towards alcohol consumption on the two islands.

As this chapter observes, the emphasis on work went beyond the medical identification of causes and symptoms of non-pauper insanity to encompass therapy. A significant tenet of moral therapy, which remained the dominant form of treatment in nineteenth-century Irish asylums, was work therapy. However, patients’ social origins impacted upon this component of their treatment as, not unlike the British context, those caring for patients from more privileged backgrounds struggled to provide for them what was considered class-appropriate employment. Unsurprisingly, for women in this study, work therapy was exclusively confined to domestic occupations, further underscoring a gender bias in Irish non-pauper asylum care. In voluntary and private asylums, doctors counteracted the difficulties they faced in occupying patients by prescribing more varied and stimulating programmes of recreation consistent with patients’ accustomed pastimes outside the asylum.

This chapter focuses on the experiences and impressions of paying patients in nine selected asylums, exploring their care and treatment primarily in the 1890s. It suggests that social status and class identity heavily influenced patients’ expectations of care. In district asylums, paying patients were particularly anxious to affirm their social standing in order to distance themselves from the pauper patients with whom they were forced to share lodgings. This, coupled with the social and political upheaval in Ireland, led to the kind of class, religious and political divisions between patients that were largely absent in the voluntary and private asylums, where the payment of higher maintenance fees translated into more ‘class-appropriate’ accommodation and treatment. Asylum doctors’ expectations of paying patients were equally informed by class and status. While wealthier patients expected to be treated with ‘respect’, their carers anticipated certain standards of ‘respectable’ behaviour in return and asylum doctors frequently commented on patients’ violent behaviour, manners, dress and appearance. These considerations were influenced by not only the doctrines of moral therapy but also the physician’s own understanding of class identity and social status. Yet, staff’s attempts to maintain a sense of social decorum in even the most expensive asylums were often frustrated by patients’ violence and ‘inappropriate’ behaviour.