Judith Pettigrew, Irene Ilott, Gwawr Faulconbridge, Anna Glynn, Ciara Egan and Naoise McMahon
In 1937 Thomas Costello (1908-1996), a registered mental nurse, was seconded from Ballinasloe Mental Hospital in County Galway in the west of Ireland to study occupational therapy for six months at Cardiff City Mental Hospital in Wales. On his return he was to set up a department. A year earlier, the Inspector of Mental Hospitals, Dr D.L. Kelly, recommended that occupational therapy be developed in Ballinasloe, suggesting that one or two staff be selected ‘to visit other hospitals where this form of treatment was carried out’.[1] Costello was chosen. He went on to lead the occupational therapy department for over thirty years.
[Fig. 1] photographic portrait of Thomas Costello: family archive.
This biography draws on Costello’s archive and on the memories of his five children and one of his granddaughters. Three of Costello’s children are/were mental health nurses, and two of his granddaughters are occupational therapists. His granddaughter Anna is one of the authors of this piece. These family remembrances offer rare insights into early occupational therapy. His family describes the therapeutic benefits of Costello’s practice and how he challenged the stigma associated with mental illness, topics that resonate today.
Occupational therapy in mental hospitals developed in Ireland (and the UK) following study tours organised by the Royal-Medico-Psychological Association to German and Dutch mental hospitals in the 1920s and 1930s.[2] The visitors were impressed that over ninety per cent of patients were engaged in productive activities.[3]In the mid-1930s, Cardiff City Mental Hospital was recognised as a training centre for occupational therapy following its participation in a 1926 study tour of Dutch and German hospitals and having established a hospital-wide service in 1930.[4]
Costello started his working life as a herdsman at the nearby Clonbrock Estate where his father worked as a butler, before becoming an attendant at Ballinasloe Mental Hospital. He subsequently trained as a mental nurse and passed the final examination of the Royal Medico-Psychological Association in November 1933 and his name first appeared on the nursing register in 1935.[5] He was one of the first in Ballinasloe to become a registered mental nurse. Costello was chosen to study occupational therapy because, according to his son Cathal, he encouraged patients to do crafts and other activities.[6] He was hardworking, reliableand did not drink alcohol.
In October 1937, Costello began a six-month secondment at Cardiff City Mental Hospital. Although little is known of his day-to-day life, the training was recorded in his notebook titled ‘Occupational Therapy Notes’.[7] This contains detailed instructions for over twenty five crafts, including making rugs, baskets, dishcloths, trays, chair upholstery, and bookbinding. There are diagrams of objects with design notes, lists of materials, and dimensions. Costello includes administrative processes such as ordering, pricing, and transportation of materials. There is an account of the organisation of the sale of crafts in the hospital. On completion of his course in April 1938, the Cardiff Resident Medical Superintendent wrote to Dr Bernard Lyons, Ballinasloe Resident Medical Superintendent, stating that the medical staff in Cardiff had ‘formed a very high opinion of Costello and his work and the doctor recommended him as highly efficient for work in the institution’.[8] Costello was also to receive training in weaving at Maryborough Hospital in County Laois.[9]
At the opening of the occupational therapy department in May 1938, Dr Lyons, said ‘those in close contact with the treatment of mental diseases looked on these departments … as the most important work towards curative treatment’.[10] This work was also useful in ‘training the patients and keeping them employed in occupations that would be remunerative to the hospital itself by providing useful articles that have to be purchased outside’.[11] The emphasis on curative treatment and efforts to maintain the hospital underscore that the approach in Ballinasloe – similar to other hospitals – combined a type of occupational therapy that originated in the US with a focus on crafts, alongside methods from the Netherlands and Germany that highlighted the importance of involving most patients in some form of useful work.
There were different pay and conditions of work for this new role. Costello’s hours changed from shift work to ‘eight o’clock in the morning until five in the evening’, which according to his son James, was a big bonus and unavailable to most nursing staff. He ‘would have been given the status of a charge nurse, which would have given him a higher wage than the rest of the people that would be working there’.
The original occupational therapy department or workshop was known as ‘the cottage’; later, the department moved to a larger location. Costello married fellow nurse Alice Wade in 1947, and their children recalled visiting the department when they were young. Imelda, his daughter, described ‘the cottage’ as ‘quite small, and it was quite cluttered’. His son Tomas remembered
the fire on and stove, people sitting around working, everybody very happy and nice relaxed atmosphere and no great pushing anybody … no orders being barked out or anything like that, you know the patients were encouraged.
Imelda said that her father ‘used to go around to the wards … and collect – bring we’ll say nine or ten people from different wards … and he’d bring them down to the workshop’. The patients could choose to come to the workshop or not. Some did so because of their interest in crafts and music, while others came for the social atmosphere.[12] The department offered a range of craft activities to suit patient interests and potential work opportunities. Costello’s daughter Assumpta commented that one patient enjoyed scrapbooking ‘Gussie Goose and Curly Wee’ cartoons. His children remember collecting sweet wrappers for others to make pictures.
According to Cathal, Costello’s son, other staff ‘would come down to work there for the day’, especially some nurses with particular skills, such as in music. James, another son, reported that additional nursing staff would spend the day in the workshop ‘if there was some individual in there that maybe needed extra minding’.
The atmosphere in the occupational therapy department at Ballinasloe was similar to that described at Grangegorman Hospital, Dublin where some nursing staff had also studied occupational therapy at Cardiff City Mental Hospital. There was an ‘air of contentment’ and a ‘homely spirit’.[13] Official visitors made these comments, and we are not aware of any patient accounts of their experience of occupational therapy.
Costello’s family emphasised the therapeutic value of Costello’s everyday practice and highlighted its practical implications, saying that many of the crafts supported the maintenance of the hospital. Imelda recalled how ‘they used to fix all the furniture that was broken in the hospital … they all went and brought it down to Tommy Costello’. There were opportunities to sell craftwork to the general public during fairs which were held within the community. James noted that money earned would be used to purchase more materials but that ‘the clients that made them would get their cut out of it as well’.
Throughout Costello’s career, those with mental illness and/or who resided in institutions like Ballinasloe were stigmatised by society. Family members talked about how their father was aware of this stigma. James acknowledged that ‘he did recognise that there was an awful lot of people in there that didn’t have psychiatric problems, that shouldn’t have been in there. But it was other circumstances…’.
Costello supported community integration through personal contact and work projects on local farms or the peat bog. Patients often visited the Costello family home. Cathal commented that growing up they ‘were sort of reared with people out at hospital, in a way’. Reflecting the societal views at the time, James noted that when visiting the workshop ‘we should have been half afraid in there, you know, because that time … [people] had the impression that everyone who was in there was quite dangerous’. This was not the case. Imelda said she ‘loved going into that workshop, we all did’. Costello treated patients the same as he would anyone else. Not everyone did this. Sometimes, family members were asked why their father brought patients out of the hospital. Such questioning did not bother Costello. In addition to his work as an occupational therapist, he had a small farm on which he grew vegetables and he also cut turf on the bog. He was a founding member of the Ballinasloe Credit Union, and this gave him great satisfaction.
By the time Costello retired in 1974, diploma-trained occupational therapists were working at the hospital. Like Costello, they were psychiatric nurses, but they had completed a three-year diploma course rather than just six months of experiential learning.
Thomas Costello was one of a number of Irish nurses who studied in Cardiff in the 1930s. Costello’s notebook ‘Occupational Therapy Notes’ shows that while the training concentrated on learning and using a wide range of crafts, it was based on the principle that participation in occupation is therapeutic, a core tenet of occupational therapy. Costello was one of many nurses who were responsible for occupational therapy in Ireland’s mental hospitals until the 1960s.
Although craft-based therapy was central to early occupational therapy, this changed with increasing pressure to become a scientific, empirical and evidence-based profession. The competence of occupational therapists was judged by their ability to explain how their interventions worked and how they would improve their methods to get better outcomes.[14] From this perspective, the contributions of dual-trained nurse/occupational therapists were disparaged, dismissed and forgotten. Yet, their practice, as glimpsed in articles and relatives’ recollections, illustrates fundamental occupational therapy principles, such as engagement in occupations, the therapeutic relationship and a facilitative environment. These were described in 1924, at one of the first meetings about occupational therapy in the United Kingdom, when the speakers at the Scottish Division of the Medico-Psychological Association affirmed that ‘the chief aim of occupational therapy is therapeutic, and not commercial or economical’.[15] Costello’s department, the cottage where the fire was lit, and the fact that people participated in different activities and played music in a positive, relaxed environment, seems to epitomise these principles.
As we continue to explore the history of occupational therapy in Ireland, registered mental nurses such as Thomas Costello deserve recognition for their pioneering efforts. Costello’s contributions to the field remind us that the early development of occupational therapy was driven by the vision and determination of individuals committed to improving the lives of those with mental illness. In 1968, Canadian occupational therapy academic Muriel Driver could have been writing about Thomas Costello when she highlighted the significance of ‘early occupational therapists’, noting that they must have ‘been possessed of strong convictions, great ingenuity, and considerable dedication … [and] we must cherish their early efforts and their admirable qualities as our historical inspiration’.[16]
Acknowledgements
We would like to thank the Costello family for sharing reminiscences of their father/grandfather and recognising the significance of his memorabilia for the history of occupational therapy. Semi-structured oral history Interviews with members of the family were conducted by the fourth and fifth authors in September 2023. The interviews were digitally recorded and will eventually become part of the History of Occupational Therapy Archive, based at the University of Limerick. Thanks also to Aimen Kakar for some editorial assistance and to Anton Faulconbridge for enhancing the clarity of the photograph.
[1] Anonymous, ‘Overcrowding in Ballinasloe’, Connacht Tribune, 20 February 1937, 7.
[2] John Hall, ‘From Work and Occupation to Occupational Therapy: the policies of professionalization in English mental hospitals from 1919 to 1959’, in Work, Psychiatry and Society, c.1750-2015 ed. by Waltraud Ernst (Manchester: Manchester University Press, 2016), 314-333.
[3] Board of Control, Memorandum on Occupational Therapy for Mental Patients (London: HMSO,1933), 9. Available at: https://radar.brookes.ac.uk/radar/items/6193364f-4c6d-41df-8d0c-75a0696e72a5/1/DH-5-2-1.pdf [accessed 30 November 2024].
[4] Eamon N. M. O’Sullivan, Textbook of Occupational Therapy with Chief Reference to Psychological Medicine (London: H.K. Lewis & Co. Ltd. 1955), 1-18; Irene Ilott, Gwawr Faulconbridge and Judith Pettigrew,‘Patricia Sunderland: an Irish Registered Mental Nurse and pioneer of occupational therapy’, Bulletin of the UK Association for the History of Nursing 1/11 (2023). Available at https://bulletin.ukahn.org/patricia-sunderland-an-irish-registered-mental-nurse-and-pioneer-of-occupational-therapy/ [accessed 30 November 2024].
[5] Judith Pettigrew, Gwawr Faulconbridge, Ciara Egan, Naoise McMahon and Irene Ilott, ‘Thomas Costello, an overlooked mid-20th century psychiatric nurse and occupational therapist’, UK Association for the History of Nursing Research Colloquium, University of Greenwich, 28 June 2024.
[6] Ciara Egan and Naoise McMahon, ‘Exploring the Contributions of Thomas Costello, mid-20th Century Occupational Therapist, from the Perspective of His Family’ (Unpublished MSc thesis, University of Limerick, 2024), 9.
[7] Ibid. 13.
[8] Anonymous, ‘Ballinasloe Mental Hospital’, East Galway Democrat, 14 May 1938, 2.
[9] Ibid.2.
[11] Ibid.6.
[12] Egan and McMahon, Thomas Costello, 11.
[13] The Irish Health Repository, Department of Local Government and Public Health, 1936. Annual report of the Inspector of Mental Hospitals for the year 1935, Grangegorman inspected 5 October 1936, 19. Available at https://www.lenus.ie/handle/10147/559044 [accessed 30 November 2024]; the Irish Health Repository, Grangegorman Mental Hospital Collection, Grangegorman Mental Hospital Joint Committee minutes 1948. Report of Inspection, Grangegorman 23 November 1948, 361. Available at https://www.lenus.ie/handle/10147/121530 [accessed 30 November 2024].
[14] Clare Hocking, ‘The way we were: Romantic assumptions of pioneering occupational therapists in the United Kingdom’, British Journal of Occupational Therapy, 71/4 (2008), 146-54.
[15] Dorothea Robinson, in ‘Occupational Therapy. A Series of Papers read at a Meeting of the Scottish Division held at the Glasgow Royal Mental Hospital on Friday, May 2, 1924’ Journal of Mental Science, 71/292 (1925), 79.
[16] Muriel F Driver, ‘A Philosophic View of the History of Occupational Therapy in Canada’ Canadian Journal of Occupational Therapy, 35/2 (1968), 54. Available at
https://doi.org/10.1177/000841746803500203 [accessed 30 November 2024].
