An Irishman's Diary

LIKE THE PAINTER Van Gogh, the Flemish city of Geel, in northern Belgium, is prone to having its name mispronounced. The G is in fact similar to the Irish “ch”, making the name sound more like “Hale” in English. And there is a humorous irony in this.

For the best part of 1,000 years, Geel has been synonymous with the treatment of health problems: mental health in particular. Moreover, centuries before anywhere else, this Belgian community pioneered the idea of “care in the community”. It is, and has been since at least the 12th century, a place of psychiatric treatment, where patients mix freely with locals and often stay in their homes.

This odd situation is the legacy of an Irish saint who may or may not have ever existed, but whose feast-day in any case falls today, May 15th. Dympna, her name was, or Damhnait (and variations thereof) in Irish. And if she did exist, her locale must have been mid-Ulster. There is a village called Tydavnet in north Monaghan, where her name is also attached to a mental hospital, while a parish in Cavan claims a link too.

Some of the doubt about her identity arises from the fact that there are variations of her story in many European folk-tales. The gist of these is that she was the daughter of a king. That she was beautiful, like her mother. That her mother died. And that the deranged father then turned his lustful attentions on her.

In the Christianised version, Dympna fled to Belgium, with her spiritual adviser. But the king followed them there, ordering the priest’s execution. When Dympna still refused his advances, he wanted her killed too. And when nobody would do it for him, he decapitated her himself.

Geel already had a strong tradition relating to the saint by the time a 13th-century Bishop of Cambrai commissioned her life story, which brought the oral history into print for the first time. The legend also gained from the discovery of two bodies, one accompanied by a brick with the letters D-Y-M-P-N-A. Thus the saint’s fame, and with it Geel’s, spread through Christendom.

Dympna being associated with insanity (her father’s) and credited with cures, Geel gradually became what was known, well into the 20th century, as a “lunatic colony”. But if the phrase is harsh to modern ears, the town’s treatment of mental patients was extraordinarily enlightened for its time.

From 1280 onwards, it had a “guest house hospital” for visitors, attached to St Dympna’s church. Even more radically, a tradition also grew up of mental patients staying with families. People who might be locked away or chained like animals elsewhere were treated with respect here, given the freedom of the community, and often working for their keep.

When, after the French Revolution, the church was closed for a time, the pilgrims still came. So the system continued, although in the mid-1800s, it was finally brought under government control. apparent success had by then made it a potential model for psychiatric treatment elsewhere and it attracted much attention, even if it was still too revolutionary to emulate.

In 1875, the New York Timesreported a visit to the town by an international medical delegation, which captures the confused sentiments of the era. "Lunacy Abroad: A Colony of Mad Men" read the headline, with sub-head noting the ratio of patients and general population: "Thirteen Hundred Lunatics to Eleven Thousand Inhabitants." But the report goes on to marvel at how the patients respond to the respect given to them and how deeply immersed the community is in their care: "A family at Gheel is not considered respectable if lunatics are not intrusted to it, and the withdrawal of them from its care constitutes a heavy punishment. The children of the inhabitants, living from their earliest childhood with lunatics . . . do not find anything ridiculous in them, learn how they are to be treated, exercise through their company a very soothing influence on them, and are of course not in the least afraid . . . when young people get married, they ask from the authorities as a favor and a sort of dowery the care of a patient."

The aforementioned Vincent Van Gogh, by the way, could have been one of those patients. Around the same time that delegation visited Geel, Van Gogh’s father considered sending his troubled son to the Belgian town for treatment. It didn’t happen, and it’s intriguing to wonder how art history might have changed if it had.

In terms of visitor numbers, Geel peaked in the 1930s, when there were 3,800 patients resident there. The figure is rather more modest now. But the city’s fame as a model for psychiatric treatment remains undimmed and its example of de-institutionalising patients has been followed widely.

It may be partly due to Geel that, for instance, St Davnet’s Hospital in Monaghan houses far fewer inmates than it once did, so that the building is these days given over to other uses, including a college and a theatre.

The latter, incidentally, is called "The Garage", and takes its name from a wistful joke about mental illness in Patrick McCabe's The Butcher Boy: being Francie Brady's description of the place his mother is sent "to get fixed".

• fmcnally@irishtimes.com