The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care, by Alice Mauger

Abstract

Reviewed by: The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care by Alice Mauger Elizabeth J. Donaldson (bio) The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care, by Alice Mauger; pp. xvi + 281. Basingstoke and New York: Palgrave Macmillan, 2018, £20.00, $31.00. Alice Mauger's The Cost of Insanity in Nineteenth-Century Ireland: Public, Voluntary and Private Asylum Care builds on a well-established and abundant body of historical work about Victorian-era asylums and is part of a field focused specifically on Irish mental health care that includes the work of Catherine Cox, Brendan Kelly, Elizabeth Malcolm, Pauline M. Prior, and others. As comparisons to English institutions illustrate, the structures of nineteenth-century Irish mental health care are distinct. In Ireland, district asylums for the poor funded by the central government flourished while private asylums grew more slowly than in England, due largely to the fact that the Irish Poor Law did not compensate private asylums for care of the indigent. While the district asylums cared for the poor and the private asylums catered to the wealthy, other social classes—those not poor enough to be considered paupers and not wealthy enough to afford private asylums—were left without clearly defined institutional care options. Eventually legal provisions were made for the inclusion of paying, non-pauper patients in district asylums, and voluntary, non-profit charity asylums were also established and offered a lower-cost alternative to private asylums for this population. In turn, private asylums competed for patients, which led to what Mauger characterizes as an "institutional marketplace" of mental health care (14). While many readers are all too familiar with the fictional madwoman in the attic depicted in Charlotte Brontë's Jane Eyre (1847), relatively little is known about the actual historical conditions of non-pauper patients in institutional care outside of the home. Mauger's attention to the economics of Irish asylums and the historically-neglected group of paying patients in asylums makes her work unique. Mauger notes that traditional historical studies of Victorian madness focus almost exclusively on poor patients in urban settings. Mauger's work, however, broadens this scope to include the neglected urban and rural middling classes by examining the records of paying patients in three different types of institutions: district (public, non-profit) asylums, voluntary (religious-affiliated, charitable non-profit) asylums, and private (for profit) asylums. By 1900, there were twenty-two public asylums housing 16,000 total patients, but the number of paying patients was very low: only fifty-three were admitted in 1889, the last year inspectors recorded this number. For paying patients, voluntary asylums provided a more attractive middle ground between overcrowded and difficult-to-access district asylums and the more expensive private asylums: by 1900, thirteen private asylums housed 300 patients and four voluntary asylums housed 400 patients. Mauger's research tracks [End Page 529] this subset of patients, the great lengths that some asylums went to in order to determine their ability to pay, and the economic anxieties of these patients and their families. For male patients in particular, Mauger notes, fear of losing employment and "the evil effects of mental strain and overwork" loomed large in the attributed causes of their admissions to asylums (149). The Cost of Insanity is based on Mauger's doctoral thesis, and this open access book offers a wealth of information culled from archival research. Historians of Victorian asylums will find the book of interest for its compilation of data, which includes information about paying patient populations, maintenance fees, length of stay, and recorded outcomes as well as breakdowns of patients' religious affiliations, occupations, and attributed causes of illness by gender in the nine Irish asylums Mauger examines. The book is replete with tables organizing this information. Sometimes Mauger's discussion remains a little too granular, however, and misses opportunities to make this data more comprehensible to a wider range of readers. Mauger records, for example, that a non-pauper patient paid an average of twenty-one pounds per annum at St. Vincent's charity asylum in 1857. Yet the book does not put expenses like these into an overarching...