Introduction
Nestled within the annals of history lies Bethlem Royal Hospital, commonly known as Bedlam, a place shrouded in mystery and controversy. As one of the world's oldest mental institutions, Bethlem has captured the imagination of scholars, artists, and storytellers alike.
The Origins of Bedlam
Founded in 1247, Bethlem Royal Hospital began as a charitable institution dedicated to caring for the mentally ill. It was England’s first asylum for the treatment of mental illness and, for many years, a place of inhumane conditions. The nickname – Bedlam – became a byword for mayhem or madness. It was also a popular London attraction for the morbidly entertained.
The Veiled Truth
Medieval thinking held that mental illness was a disease of the body, not of the brain, which could be cured using strong medicines to purge the individual of ‘melancholic humour’, including inducing recurring bouts of vomiting and diarrhoea and bleeding from the veins. The skin would be blistered with caustic substances and patients would have their heads shaved and be placed in cold baths. This regime would be administered repeatedly as long as ‘the strength would bear’. It inevitably led to their deaths. This treatment was still universally accepted even in 1676, as Bethlem remained Britain’s only mental health facility. It had developed a nepotistic tradition which saw medical posts pass between friends and family, ensuring that treatment methods were similarly inherited.
Treatment of Patients
By the 1750s, Bethlem accepted tens of thousands of paying visitors annually, making it a top tourist attraction for Londoners. For as little as a penny, anyone could gain access to Bethlem’s wards to stare at, taunt or abuse inmates.
By modern standards, this behaviour seems cruel and counterproductive to the patient’s mental health. However, 18th-century medicine dictated that mental illness robbed the individual of shame, emotion and reason to the extent that any verbal or physical abuse they suffered could surely have no lasting effect.
The staff, including Bryan Crowther, a surgeon at Bethlem, were reported to be “generally insane and mostly drunk”. The doctor, Thomas Monro, preferred collecting art to medicine. His visits to Bethlem were infrequent and brief, and never involved touring the patients’ wards.
Emergence of Mental Prisons
The 18th century saw a rapid expansion in London’s population and also a decline in the traditional treatment of insanity. Bethlem had space for just over 120 patients and a long waiting list for admissions. As a consequence, many private ‘madhouses’ appeared around London, some of which were no more than unregulated prisons that enabled families to lock up perfectly sane but inconvenient relations.
The Reformation
A committee was formed to inspect the workings of the hospital, The sight that most shocked the committee was that of James Norris, described as a clear and lucid man, whose neck had been tightly chained to an iron bar in the wall. With additional metal restraints on his chest, waist, feet and arms, Norris complained that his muscles were atrophied and painful following a decade of confinement.
The staff described Norris as violent and dangerous but to the committee he seemed quiet and perhaps even sane. The inspectors had seen enough and called for a Parliamentary inquiry into conditions at Bethlem.
In 1815, Bethlem was moved from its collapsing Moorfields site to a brand new building at St George’s Fields, south of the Thames River. Lessons had been learned and the new members brought about long overdue reforms. An 1818 report found patients “clean, amply supplied with wholesome provisions and well clothed with none under restraint”
The Legacy of Bedlam
Today, Bethlem Royal Hospital stands as a beacon of hope and healing, a far cry from its inhumane past. As society continues to grapple with mental health stigma and discrimination, Bethlem serves as a reminder of the need for compassion, understanding, and empathy towards those struggling with mental illness.
Its transformation mirrors the shifting attitudes towards mental illness throughout history, reflecting society's perceptions of madness and its treatment.
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