Professor Kelly has been a prolific author of both research articles, reviews and books in the area of psychiatry. This is not his first time blending his qualifications as a historian and as a psychiatrist to provide a unique perspective of the mental health profession and to how we got to where we are today. The book is primarily for the academic reader, but it is very accessible to the general reader. It is well researched and referenced. As it was intended, it will form a firm foundation for researchers in the future.
One issue that the book highlights is the innumerable commissions and committees that have been established to examine the state of the mentally disordered in Ireland over the last 200 years and how the changes are slow and uneven. In the end, it seems to come down to individual actors and the zeitgeist of the era. We are currently in the era of a human rights approach to the mentally ill. This is an era that is well and accurately covered in the book. Professor Kelly has himself been a major contributor to these human rights changes in how the mentally ill are treated, reflecting his considerable qualifications in human rights law. I was delighted to see coverage of the work of Professor Robert Daly in the area of human rights. Professor Daly has made a very large contribution to this country and internationally to human rights in general at great personal cost. This in my opinion, will be the story that future historians will be examining, though his work is largely unknown to the younger members of the psychiatric profession.
I was disturbed to learn the emphasis that some psychiatrists such as Dr G.W Hatchell, of the Castlebar District Asylum and others in the late 19th century placed on tea as a predisposing factor for insanity. If this is the case I am in trouble. The most shocking aspect of the book is the treatment of the mentally ill in what were called Houses of industry (The Poor House). It resemblance to what one would find in some of the worst prisons in the world was striking. It was in this regard that the asylums served a purpose. They gradually emptied the Houses of Industry and the prisons of the mentally ill and provided a more humane environment for those deemed to be insane. The discharge rate from the asylums were very low. As treatment in the community has developed especially following the publication of Planning for the Future in 1984, it has provided a mixed blessing for the mentally ill. The reason is clear. It is the under-resourcing of the mental health budget which now lies at 6% of the overall health budget. This is despite empty promises and gestures by politicians as they utilize the area of mental health as a vehicle to advance their political careers.
Professor Kelly ventures into psychiatry of the present day. He outlines different individuals that he feels have had a positive impact upon the development of psychiatry in Ireland. This is always a difficult area to address as many of these people are still alive or they are recently deceased. This Professor Kelly recognizes and he is utilizing this section of the book as a guide for future scholars to examine. As a result, the individuals are written about in only a positive light and their human failings are necessarily ignored.
The book is mainly about psychiatrists and it records the paternalistic aspect of the profession up to and still including the present time. It is a reminder that meaning to do to good does not mean that you are doing good. I suspect that we are making the same mistakes with the addicted as we made with the mentally ill in the past. Many are homeless, in prison or living in squalor. For this and many other reasons, I would advise all practicing psychiatrists, psychiatric trainees and mental health professionals to read this book. It is only by knowing where we have been, do we know where we are going.
Conflicts of Interest
The author is known to the reviewer.
