Bedlam

The Bethlem Royal Hospital of London is a psychiatric hospital in Beckenham, south east London. Although no longer in its original location and buildings, it is recognised as the world’s first and oldest institution to specialise in the mentally ill. It has been variously known as St. Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam.

The word bedlam, meaning uproar and confusion, is derived from its name. Although the hospital is now at the forefront of humane psychiatric treatment, for much of its history it was notorious for cruelty and inhumane treatment – the epitome of what the term “madhouse” connotes to the modern reader.

History of Bethlem

Bethlem has been a part of London since 1247, first as a priory for the sisters and brethren of the Order of the Star of Bethlehem, from where the building took its name. Its first site was in Bishopsgate (where Liverpool Street station now stands). In 1330 it became a hospital, and it admitted some mentally ill patients from 1357, but did not become a dedicated psychiatric hospital until later. Early sixteenth century maps show Bedlam, next to Bishopsgate, as a courtyard with a few stone buildings, a church and a garden. Conditions were consistently dreadful, and the care amounted to little more than restraint. There were 31 patients and the noise was “so hideous, so great; that they are more able to drive a man that hath his wits rather out of them.” Violent or dangerous patients were manacled and chained to the floor or wall. Some were allowed to leave, and licensed to beg. It was a Royal hospital, but controlled by the City of London after 1557, and managed by the Governors of Bridewell. Day to day management was in the hands of a Keeper, who received payment for each patient from their parish, livery company, or relatives. In 1598 an inspection showed neglect; the “Great Vault” (cesspit) badly needed emptying, and the kitchen drains needed replacing. There were 20 patients there, one of whom had been there over 25 years.

In 1620, patients of Bethlem banded together and sent a “Petition of the Poor Distracted People in the House of Bedlam (concerned with conditions for inmates)” to theHouse of Lords.

The Hospital became famous and notorious for the brutal ill-treatment meted out to the mentally ill. In 1675 Bedlam moved to new buildings in Moorfields designed byRobert Hooke, outside the City boundary. The playwright Nathaniel Lee was incarcerated there for five years, reporting that: “They called me mad, and I called them mad, and damn them, they outvoted me.”[1]

The lunatics were first called “patients” in 1700, and “curable” and “incurable” wards were opened in 1725-34. In the 18th century people used to go to Bedlam to stare at the lunatics. For a penny one could peer into their cells, view the freaks of the “show of Bethlehem” and laugh at their antics, generally of a sexual nature or violent fights. Entry was free on the first Tuesday of the month. Visitors were permitted to bring long sticks with which to poke and enrage the inmates. In 1814 alone, there were 96,000 such visits.

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Eighteenth century Bethlem was most notably portrayed in a scene from William Hogarth’s A Rake’s Progress (1735), the story of a rich merchant’s son whose immoral living causes him to end up in a ward at Bethlem. This reflects the view of the time that madness was a result of moral weakness, leading to “moral insanity” being used as a common diagnosis.

In 1815, Bedlam was moved to St George’s Fields, Southwark (into buildings—designed by Sydney Smirke—now used to house the Imperial War Museum), where the inmates were referred to as “unfortunates”. This building had a remarkable library as an annex which was well frequented. Although the sexes were separated, in the evenings, those capable of appreciating music could dance together in the great ballroom. In the chapel the sexes were separated by a curtain. Finally, in 1930, the hospital was moved to an outer suburb of London, on the site of Monks Orchard House between Eden Park, Beckenham and Shirley.

In the early modern period it was widely believed that patients discharged from Bethlem Hospital were licensed to beg, though in 1675 the Governors denied this. They were known as Abraham-men or Tom o’ Bedlam. They usually wore a tin plate on their arm as a badge and were also known as Bedlamers, Bedlamites, or Bedlam Beggars. In William Shakespeare’s King Lear, the Earl of Gloucester’s son Edgar takes the role of a Bedlam Beggar in order to remain in England unnoticed after banishment. Whether any were ever licensed is uncertain. There were probably far more who claimed falsely to have been inmates than were ever admitted to the hospital.

In 1997 the Bethlem hospital started planning celebrations of its history on the occasion of its 750th anniversary. The service user perspective was not to be included, however, and members of the Consumer/Survivor/Ex-Patient Movement saw nothing to celebrate in either the original Bedlam or in current mental health care. A campaign called “Reclaim Bedlam” was launched by Pete Shaugnessey, which was supported by hundreds of patients and ex-patients and widely reported in the media. A sit-in was held outside the original Bedlam site at the Imperial War Museum. Historian Roy Porter has called the Bethlem Hospital “a symbol for man’s inhumanity to man, for callousness and cruelty.”

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