Professor Brendan Kelly is Professor of Psychiatry at Trinity College Dublin, Consultant Psychiatrist at Tallaght University Hospital, Dublin, and UCD Visiting Full Clinical Professor at UCD School of Medicine, University College Dublin. He has authored and co-authored over 300 publications in peer-reviewed journals, over 600 non-peer-reviewed publications, 21 book chapters and book contributions, and 17 books (11 as sole author). He speaks to Dr Emma Farrell about his recent book Asylum: Inside Grangegorman (2023).
Emma Farrell: Professor Kelly, you’ve written arguably the official history of psychiatry in Ireland, in your 2016 book, Hearing voices: The history of psychiatry in Ireland. How is this book different?
Asylum was an effort to give clearer voice or more direct account of the experiences of people who are admitted to psychiatric hospitals
Brendan Kelly: The history of psychiatry, including my book Hearing Voices is very much the history of a discipline, or practices and institutions and buildings with some stories of people who came in contact with them. But really this new book Asylum was an effort to give clearer voice or more direct account of the experiences of people who are admitted to psychiatric hospitals or mental institutions or lunatic asylums to use all these words that are no longer acceptable. And rightly so. Ideally, I would have had letters and diaries written by patients themselves, people who were in these institutions, but there's very little of that available. The book does include some of the writings of some patients, but these tend to be indirect accounts rather than a day-by-day diary. So, the book is an attempt to move closer to the experience of what it was like to be in, in this case Grangegorman, one of the mental hospitals.
Emma Farrell: And that in many ways brings us to my second question. There are great opportunities in being able to access historical medical records, and you can see them so clearly in your book, but there are also limitations in terms of, as you've already mentioned, we don't get to hear directly from the people that are being often written about. Were you mindful of the power imbalance that is inherent within the documents that you were working with when writing the book?
Brendan Kelly: Yes, I mean, I was working with medical records that were created by the people who create medical records so they are a particular interpretation of experience, a particular way of placing people into diagnostic categories. I was very mindful of that right through the writing of the book. In various places the creator of the records, often the doctors, did record direct quotes from what people said - or at least that what is what it appears to be, they used inverted commas - so I tried to use that, imperfect though it was, where possible. And also the writings of some people from inside Grangegorman. But there really was very little. And then the book opens with a letter from the sister of somebody who was in Grangegorman so, I guess I did try to reach as far as the medical record permitted into this area. Now the Grangegorman Histories project has an oral history project that is recording oral histories from people who had experience of Grangegorman. These people tend to be in later life and so it is a project with some urgency. But I was aware of the power dynamics which are interesting in themselves.
Emma Farrell: One of my favourite of your lines is the opening sentence of hearing voices, a sentence that is present in Asylum in a slightly different form:
“The history of psychiatry is a history of therapeutic enthusiasm, with all of the triumph and tragedy, hubris and humility that such enthusiasm brings.”
Can you tell us what you mean by that?
Brendan Kelly: Oh, you know I can see it in Asylum that there's this recurring desire to help. We, as humans, identify others of us as being in need of help, or they identify themselves. We identify ourselves. And in psychiatry this desire to treat is a recurring feature. It's like, it's like waves.
And this is perhaps most obvious in the establishment of all these mental hospitals, as they were called to begin with. They were designed to help the ‘lunatic poor’, so, there was this embedded awareness from the word go, that poverty and social circumstances were part of what was happening here, you know.
But then the other place where this therapeutic enthusiasm is demonstrated, is in the early part of the twentieth century with this succession of biological treatments for various people. So there was malaria therapy, insulin coma therapy, lobotomy, and when you drill into these you find those instigating them were motivated by a desire to help. But there was not a system to evaluate outcomes systematically. And that's when the therapeutic enthusiasm turns into hubris and often with enormous support. So, for example, in the in the United States. Henry Cotton, a doctor who ran an asylum developed the belief that infections were responsible for a great deal of mental illness or madness, as it might have been called, and decided that the correct approach was surgical. So, people had all their teeth removed, for example, to remove the possibility of infection. And what's interesting is that, you know, the idea of infection affecting the brain is not unreasonable. However, the treatment was unproven, but it was wildly popular. People rushed to get this. So, this therapeutic enthusiasm is not limited to doctors. It's shared very often, and it shades very quickly into therapeutic desperation.
This therapeutic enthusiasm is not limited to doctors. It's shared very often, and it shades very quickly into therapeutic desperation.
This interview concludes on the 22nd February
Professor Brendan Kelly is Professor of Psychiatry at Trinity College Dublin, Consultant Psychiatrist at Tallaght University Hospital, Dublin, and UCD Visiting Full Clinical Professor at UCD School of Medicine, University College Dublin. In addition to his medical degree (MB BCh BAO), he holds masters degrees in epidemiology (MSc), healthcare management (MA), and Buddhist studies (MA), and an MA (jure officii) from Trinity College Dublin; doctorates in medicine (MD), history (PhD), governance (DGov), and law (PhD); and a higher doctorate in history (DLitt).
He has authored and co-authored over 300 publications in peer-reviewed journals, over 600 non-peer-reviewed publications, 21 book chapters and book contributions, and 17 books (11 as sole author). His recent books include Asylum: Inside Grangegorman (2023). He is a Fellow of the Royal College of Psychiatrists, Royal College of Physicians of Ireland, and Trinity College Dublin. In 2018, he became Editor-in-Chief of the International Journal of Law and Psychiatry and in 2020 was elected as Dun’s Librarian at the Royal College of Physicians of Ireland.
