How to manage human pain
Cavan woman pens book on overlooked history of Irish psychiatric nursing
Previously unrecorded, unrecognised and forgotten, Dr Eithne Cusack has compiled untold stories of nurses who worked in Irish psychiatric institutions from the 1940s to the end of the 20th Century. Through first-hand accounts, the Ballyhaise native provides an unprecedented insight into conditions and treatments within the asylum system – often to the detriment of what they were meant to improve: the mental health of uncounted people.
Upon completing her Leaving Cert in Loreto in 1977, Eithne Cusack went on to study psychiatric nursing in St Brendan’s Hospital in Grangegorman, Dublin. Over the years, she worked in a variety of services in the mental health field ranging from acute, residential, community, to forensic and specialist psychotherapy services in both clinical and management roles, before writing her doctoral thesis about the situation of psychiatric nurses. 'Making the Walls Porous; A Narrative History of Psychiatric/Mental Health Nursing in 20th Century Ireland’ has since been published geared at a wider audience.
“Psychiatric nurses were the largest workforce within psychiatric hospitals and it is a unique discipline of nursing with its own identity, yet very little if anything is known of its existence within these asylums and hospitals,” she explains the reasons for her interest.
“Their narratives provide valuable knowledge and insight into the experiences and practices of psychiatric nurses, their influence on patient care, and the changes in mental health care in Ireland.”
Containment
In her book, Eithne Cusack describes how asylums - synonymous with a “terminal diagnosis” - were one component of a broad ‘architecture of containment’ which existed in Ireland in the 20th Century. Reformatory and industrial schools as well as Magdalene Laundries formed this network “tasked with the moral reform of Ireland’s so-called fallen and immoral”.
Eithne Cusack’s conclusion is bleak: “Patients were locked away; societal problems and fears were kept in the dark and stigma and discrimination grew in intensity.”
Even if a person was able to leave the asylum at some point, the shame of being a patient haunted them for the rest of their lives in a society “who perceived them weak minded and hopeless, allowed them to be forgotten and ignored.”
Powerless
The narratives collected by Cusack are not only stories of personal experience but also, accounts of how deeply embedded the nurses were within the various institutional structures that influenced their careers. They recalled that the all-male Resident Medical Superintendents held dominant authority in governance, morality, and administration, presenting themselves as prestigious and intellectually superior. Psychiatrists also commanded local social, economic, and political power, leaving nurses powerless within this patriarchal system.
Their rank based on a flawed background, as Cusack points out: “By the late 1970s, when I started psychiatric nurse training, psychiatry rested on weak evidence, and both psychiatry and psychiatric nursing lacked scholarly grounding.”
Sorrow
When composing her research, she encountered many nurses, who showed reservations in conveying their experiences. “They expressed sorrow for patients incarcerated within these institutions, especially for those who they believed were wrongfully detained and how they were compelled to conform.”
Given the overbearing hierarchy, the nurses believed they were unable to influence the patriarchal system of governance that existed at that time.
In Cusack’s opinion, the secrets that were covered but not hidden became more and more of a burden – initially borne by the patients and nurses.
“It impacted hugely on the quality of both parties’ lives, for many nurses this burden was both personal and professional,” recites Cusack of her findings. “How prepared were these nurses to manage the enormity of this human pain?”
Despite their position, Cusack saw how these nurses evolved “to meet the needs of patients offering them care, hope and humanity in a system more often defined by its failures.”
In the 1980s Government policy led to the closure of asylums, later called mental hospitals and subsequently psychiatric hospitals. As a nurse, Eithne Cusack was involved in the rehabilitation process and the relocation of patients from these institutions. In 1998 a Commission of Nursing was set up by the Irish Government to reorganise the profession of nursery and midwifery. It identified the lack of input in healthcare planning and policy making by nurses and midwives and subsequently, new planning and development units were established. Eithne Cusack was promoted to a director role in one of these.
“It was here that I noticed that very little information existed on the practice of psychiatric nursing, the context in which psychiatric nurses worked and the patients they cared for. I believed a professional obligation existed to fill this gap.”
She has since made it her mission, to ensure that the contribution of this group of nurses and this nursing history is not lost and is incorporated into healthcare in Ireland.
She attributes the conclusions to the most vulnerable in this system.
“I believe the patients educated us, the hospitals served as universities for understanding human life and human suffering, revealing the profound impact of neglect, abuse and trauma on people’s lives, it offered us a deep insight into human vulnerability. These patients taught us the art and craft of psychiatric and mental health nursing.”