Hearing Voices: Lessons from the History of Psychiatry in Ireland.

The history of psychiatry is a history of therapeutic enthusiasm, with all of the triumph and tragedy, hubris and humility that such enthusiasm brings. During the 1800s and early 1900s, Ireland-s public asylums were routinely overcrowded, unhygienic and, quite commonly, fatal. The asylums became all-too-convenient options for a society with an apparently insatiable hunger for institutions, incarceration and control. The emergence of clinical professionals, both medical and nursing, was inevitably a factor in this complex mix, but the effects of any search for professional prestige were dwarfed by asylum doctors' clear outrage at what the asylum system became. There were powerful, non-medical, vested interests in keeping large asylums open. Irish society consistently failed to generate solutions to real human suffering (mental illness, disability, disease, poverty, ill fortune) other than the extraordinary network of institutions that characterised so much of Irish history: orphanages, industrial schools, reformatories, workhouses, laundries, borstals, prisons and asylums. As a result, Ireland's remarkable asylum system was primarily a social creation rather than a medical one. Notwithstanding this complex history, Ireland's mental health services have been transformed over the past five decades, although real challenges remain, especially in relation to the homeless mentally ill, the mentally ill in prison, and providing meaningful support to families.