Saint Dymphna – A Long Dead Teacher of Psychiatry by David Killilea

There are times when it pays to take advantage of coincidence. I am a final year medical student at University College Dublin and was walking past the National Gallery when I saw an advertisement for an upcoming exhibit entitled “St Dymphna: The Tragedy of an Irish Princess”. It was only a few months back when a member of my family told me that Saint Dymphna was Irish and is the patron saint of mental illness (also psychiatry but naturally that only arrives on scene after the first). I filed this fact away and let it degrade alongside some anciently imbibed anatomy. It sprung free on seeing this notice, however, and was further justified in its breakout when I read that PsychSIGN was seeking pieces for its upcoming publication on the theme of “Roots & Bloom”.

Let me introduce psychiatry’s patron saint and her short, though significant life. Born the daughter of the King of Oriel in modern-day Northern Ireland in the 7th century, Dymphna was regarded as nothing short of prepossessing and grew to become something of a doppelgänger of her mother. Her death early in Dymphna’s adolescence fuelled her father’s search for a replacement of equal beauty. He was unsuccessful, and, so Dymphna was chosen as the only possible option to him and pressed into an incestuous relationship. This was at odds with Dymphna’s sense of decency and her Catholic faith, which she shared with her mother but not her father. At 14, Dymphna had taken a vow of chastity to enable her to be free of worldly desires so she could focus on charity and good works. With her celibacy at risk, she fled to the continent with a priest and entourage, plus as much gold and silver as they could carry. Arriving in the Belgian town of Geel they established a proto-hospital for the mentally ill and homeless. In order to be venerated a saint, one is required, amongst other criteria, to have performed ‘miracles’. This, apparently, was Dymphna’s forte. So many were ‘cured’ that her treatment centre became a place of pilgrimage. Her father soon discovered her and demanded she return to Ireland and wed him or suffer death. She chose the latter and was martyred. A church of veneration was erected in 1349 in Geel which continued to draw those suffering to the town. Care of arrivals was undertaken by clergy, townspeople and, more often than not, within family homes–an early example of institutional and community care working symbiotically. This evolved to a tradition that still exists where arrivals, termed ‘boarders’, are given work within the community and in the surrounding fields. Stigma does not occur within Geel, it is kept at the municipal boundary never to enter.

When one thinks of where great advances have occurred in European psychiatry, one’s mind turns to the Maudsley Hospital, Bethlam Royal in England, the Salpêtrière in Paris, and the Burghölzli outside Zürich. But this overlooks the dialectic that is inbuilt in psychiatry. Treatment is but a step; acceptance on return to family, friends and a community is of arguably greater importance.

Success of this kind has occurred in Geel and, more famously in Trieste and their celebrated model of psychiatric care. Before the great institutions of psychiatry, the unwell were either outcast or welcomed, despite Dymphna’s supposed feats, as cures were in short supply. Care and understanding by a person’s community was the closest to intervention they might ever receive. Setting aside religion, Saint Dymphna’s legacy has much to offer the reflecting psychiatrist on where we should place emphasis in our interventions. The hangover from deinstitutionalisation remains in much of Europe and North America because of this lack of acceptance. Our Everest will be to facilitate and engender this amongst the communities we work in, and build on the tradition of Geel.