In spite of the Irish psychiatric community’s inertia in solving the drink question, in their daily practice asylum doctors regularly identified and attempted to treat alcohol-related illnesses. Asylum admissions related to alcohol remained consistently high in the decades leading up to independence. According to the lunacy inspectors, in 1890 one in eight men and one in twenty-two women were admitted to district asylums for ‘intemperance’.85 In December of that year, one in eleven men and one in twenty-six women were in voluntary and private asylums owing to ‘intemperance in drink’.86 In the last report published prior to independence in 1919, alcohol was considered the chief cause for one in sixteen patients and one of multiple factors for almost one in ten, with rates remaining higher for men than for women.87

While drink was very often identified as a cause of insanity, alcohol-related diagnoses were far less common. Among those admitted to district asylums in 1890, just one in seventeen men and one in thirty-five women were diagnosed with mania a potu, a form of insanity attributed to excessive alcohol consumption, which, like mania itself, was characterised by excited or violent symptoms and sometimes identified with delirium tremens.88 Reflecting the approval of private asylums as suitable establishments for inebriates, mania a potu was more commonly diagnosed in patients admitted to voluntary and private asylums; in the same year, one in thirteen men and one in fourteen women were diagnosed with this disorder.89 By 1909, the last year for which figures for mania a potu or any other alcohol-related disorder were included in the annual reports, this pattern was reversed with one in sixteen of men and one in fifty-six women sent to district asylums diagnosed with this disorder, compared to one in eighteen men and only one in 143 women sent to voluntary or private asylums.90

The trends are similar for patients admitted to Belfast, Enniscorthy and St. Patrick’s asylums. Nearly all of the alcohol-related admissions to these institutions were attributed to alcohol. Of these 901 patients, 524 were assigned alcohol only, a further 246 were assigned the additional cause of heredity, but only 160 were diagnosed with an alcohol-related disorder. Instead, almost half were diagnosed simply with mania. This departs significantly from trends in the Sainte-Anne asylum in Paris, where diagnoses of alcoholism made up almost a quarter of male admissions, and was said to have contributed to a further 7.3%.91 These divergences in diagnostic and aetiological categorisation in the Irish case reflect different medical understandings of alcoholism as a contributing factor of mental disorder rather than mental illness itself. Of course, the causes assigned tell us as much about lay, as they do medical definitions. The medical certificates which accompanied patients on admission allowed certifying doctors—usually not psychiatrists—to record cause of illness, and this was heavily based on information provided by family and friends. On admission, asylum doctors could then choose to confirm or alter this information.92 While medical rather than lay authorities therefore had the final say over what was recorded, there is little doubt that the attitudes towards alcohol of those committing patients, including poor law and judicial official, friends, relatives and even the patients themselves, were represented.93

Case notes for individual patients shed light on the diverse criteria applied when citing alcohol as a cause of illness. Both the quantity of alcohol taken and the length of time a patient had been drinking varied widely. At Belfast, one patient assigned the cause of ‘drink’ had reportedly ‘been drunk all his life’, yet another had been drinking hard for only two weeks prior to taking ill, consuming ‘110 glasses of whiskey in the fortnight’.94 Meanwhile, an Enniscorthy patient told his doctor that ‘he occasionally drank a good deal of porter, up to 7 or 8 bottles in the day if he was out on duty or with friends but this would not incapacitate him from business’.95 The criteria were equally eclectic at St. Patrick’s. While Patrick D. was described as ‘very intemperate – 1 pint at least of whiskey being taken for years daily’, Patrick C. was said to have ‘been drinking but not recently’.96

It is striking how frank many patients were in conversations with asylum doctors. This contradicts the general consensus among many Irish medical practitioners, discussed above, that the drunkard could not be trusted and usually denied their drinking. Patients and their relatives often attempted to rationalise why they drank to excess. As will be discussed later, the sheer number of public houses and resultant availability of drink was cited as a frequent cause for relapse among patients. Another common theme was the death of a loved one.97 Maria D., admitted to St. Patrick’s with ‘alcoholic insanity’ in 1904, was ‘reported to have taken 1½ pints of brandy per day for some time’. She later stated that ‘her intemperance was due to shock consequent upon the sudden death of her son’.98 In a particularly heart-wrenching set of circumstances, Anne L. was admitted to Enniscorthy in 1904 for melancholia caused by the ‘death of child and drink’. Anne had buried five or her six children who had all died under the age of eighteen months, and her husband stated that after the last child died, ‘she fretted after him and he says people gave her whiskey. He can’t say how much but too much’. Anne later confirmed her husband’s explanation and was discharged recovered the same year.99 Links between excessive drinking and mourning were not confined to female patients. When Patrick H. was admitted to Enniscorthy in 1909, diagnosed with acute melancholia, the causes assigned were ‘predisposing: heredity; exciting: death of wife and children – drink’. Patrick presented himself at the asylum and asked to be taken in saying that his ‘“head was wrong” since the death of his wife and he feared he would do some harm to himself and thought of drowning himself in a hole of water’. Patrick’s wife had died while giving birth to twins who both died nine days later.100 Another patient, James J., told his doctor that ‘ever since his father was drowned in the Noir [river] he has “been a fearful man for drinking”’.101

102 103 Drinking and derangement were all due to his wife “who ought to be in the asylum instead of him”. She drinks twice or thrice times what he’d drunk. Used to go away from him for 3 or 4 months and then when he had no comfort at home he would go to the publics [public houses] and drink mostly beer: little or no whiskey”… He says that he (patient) was convinced that his wife was trying to poison him. That he is a right good fellow and that every one of the neighbours “would die for him.” In a number of cases, both halves of a married couple reportedly drank to excess and were seen as a bad influence on one another.The brother of one Enniscorthy patient told Drapes that ‘he thinks it was his wife get him deranged, as she drinks too … he did a splendid business and was most popular, but thinks that it has gone more or less to [?] since both he and wife took to drink’.Similarly, the brother-in-law of another patient, William McN, told Drapes he believed the patient’s:

When William was discharged less than a month later and his wife came to collect him, Drapes noted that she had ‘the aspect of a drinking woman’.104 These examples correspond to Holly Dunbar’s finding that women, and especially wives, were expected to steer men away from vices and towards sobriety.105 Yet, at least in Enniscorthy, criticism of a patient’s spouse was not limited to one gender. In 1906, patient Barbara B.’s illness was ascribed to both ‘drink’ and ‘husband’s intemperance’ and the patient told Drapes that ‘her attack was caused by annoyance of her husband drinking’. She did, however, admit to drinking up to ‘two, four or even six bottles of porter’ when they were given to her. On a visit from her husband, the assistant medical officer, Dr. Hugh Kennedy, clearly sympathised with the patient, writing of her husband that ‘he had drink taken and attempted to beat her – when prevented by Attendant Hanna Fenlon became very cheeky and abusive’.106 Cases like these demonstrate that in the eyes of medical staff, both husbands and wives were potentially corrupting influences on their spouses.

Insight into the type of people admitted to asylums for excessive drinking or alcoholism can also be gleaned from patient records. A typical case for the period from 1890 to 1921 was a man in his thirties or forties, who had usually been married, was Roman Catholic and had worked in either the agricultural or industrial sector. The much higher level of male admissions is expected, given that alcoholism has historically been viewed as a male problem.107 Thus, while men were often over-represented, especially among those committed to rural asylums,108 they were considerably more likely than women to be described as suffering from alcohol-related illnesses (between 67.7 and 87%). Prestwich has found similar in her study of alcoholics committed to the Sainte-Anne asylum in Paris, reflecting the lack of public medical attention geared towards female alcoholism in the late nineteenth and early twentieth centuries.109 By the First World War, however, there was well-documented alarm over female alcoholism, in both Ireland and abroad. Dunbar has chronicled the contemporary revulsion for women who drank excessively during the First World War in Ireland, a theme which Prestwich has identified in the French context.110 These anxieties have been linked to women’s changing role in society, while alcoholism in women was often associated with sexual immorality.111 Notably, women’s excessive drinking may have more frequently been seen as criminal, as they were more likely to be sent to inebriate reformatories than men.112

The occupational profile of male patients in this study contrasts somewhat with Prestwich’s characterisation of male alcoholic patients admitted to the Sainte-Anne asylum in Paris, who ‘with the exception of those in the wine and alcohol trades, were more likely to be vagabonds and unskilled or skilled workers and less likely to be drawn from the petty bourgeois categories of clerks and shopkeepers’.113 Predictably, the ‘agricultural class’114 made up three-fifths of rural Enniscorthy’s male alcohol-related admissions. The ‘industrial class’, which includes dealers, publicans, shoemakers, carpenters, shopkeepers and tailors, was well represented in both Enniscorthy (21%) and Belfast (36.8%), while the professional and commercial classes were over-represented among patients sent to Belfast (12.8%) and St Patrick’s (14.3%). In fact, those in the ‘indefinite and non-productive class’ are a good deal lower than the national picture.115 While this may tell us more about the recording process than implying higher levels of employment among alcohol-related admissions, the figure of 40% unemployment among (male and female) alcohol-related admissions to St. Patrick’s is at odds with Malcolm’s finding that by 1884, nearly two-thirds of the general patient population had no occupation.116 What is clear is that the men committed to the asylums studied were by no means unproductive layabouts, who had long ceased to provide for themselves and their relatives. To use the dictum of the time, they might be considered those who had fallen on hard times or the ‘deserving poor’.

The same can be said for the female patients, who were over-represented in the industrial classes at both Belfast (27.6%) and Enniscorthy (19.1%) compared to the national figure of 8.1% in 1911. This group included weavers, dressmakers, spinners, dealers and millworkers. In international contexts, occupations like ‘dressmaker’ have been revealed as euphemisms for prostitute and some known prostitutes in Ireland were returned in the 1901 census as dressmakers, housekeepers, waitresses and milliners.117 However, given that the occupations of seven patients (3.8%) in this study were explicitly recorded as prostitute, it is unlikely that this was the case here. The proportion of women recorded as having ‘no occupation’ is also low by the standards of total district asylum populations, for whom this was usually the largest category, followed by those in the agricultural class.118 This high level of employment mirrors that of women admitted for alcoholism to the Sainte-Anne asylum, who were also disproportionately likely to have worked outside the home. In the Parisian context, women in certain occupations, including cooks, laundresses and male and female wine traders, were reported to have regularly ‘drank on the job’.119 Again, this could be seen as reflecting anxieties about increased activity of women in the workplace and by extension, in the public sphere.120 This line of thought has been visible in modern discourses, where since the 1980s the growing visibility of women in the workforce has given rise to the stereotype that women performing ‘men’s work’ have come to replicate ‘men’s vices’. Conversely, and as Prestwich has argued, given their knowledge that working-class women led ‘hard lives’, French psychiatrists accepted that women, like men, might develop job-related or occupational alcoholism.121

Another defining characteristic of alcohol-related admissions to asylums was the short periods of time they tended to remain incarcerated.122 Like most asylum patients, half the patients in this study stayed for less than six months. Longer stays of five years or more accounted for only 17.6% compared to over a quarter of all asylum patients.123 Those admitted to St. Patrick’s stayed the shortest length of time, with almost three quarters released within the first year. Gender apparently impacted on rates of discharge: women were slightly less likely (58.2%) than men (66.5%) to be released within a year while they were more likely (15.3%) than men (10.1%) to become long-term patients of ten years or more. Those who stayed longer had much higher chances of dying in the asylum, with 71.1% of those staying between five and ten years and 93.2% of those staying ten years or more doing so. Short-term patients, on the other hand, had very high chances of recovery: 73.1% of those released within six months were described as ‘recovered’ and a further 12.3% as ‘relieved’. Repeated admission, a substantial characteristic in all Irish asylums, was also a remarkably strong trait among those suffering from alcohol-related illness, both in Ireland and internationally.124 While tracing readmissions is not an exact science, at the very least, one in ten patients in this study was returned to the asylum and references to previous confinements in other institutions were not infrequent. Unlike those readmitted to the Sainte-Anne asylum, who after two or three times were deemed incurable, readmissions did not seem to impact negatively on the outcome of patients’ stays.125 In fact, many of those admitted repeatedly were likely to be discharged recovered.