This Way Madness Lies

The Asylum and Beyond

Mike Jay

• Publisher: Thames and Hudson Ltd
• Year: 2016
• Topic: History
• eBook ISBN:
  9780500773628
• Subtopic: Social History
• Index: History

Is mental illness or madness at root an illness of the body, a disease of the mind, or a sickness of the soul? Should those who suffer from it be secluded from society or integrated more fully into it? This Way Madness Lies explores the meaning of mental illness through the successive incarnations of the institution that defined it: the madhouse, designed to segregate its inmates from society; the lunatic asylum, which intended to restore the reason of sufferers by humane treatment; and the mental hospital, which reduced their conditions to diseases of the brain. Moving and sometimes provocative illustrations and photographs, sourced from the Wellcome Collection's extensive archives and the archives of mental institutions in Europe and the U.S., illuminate and reinforce the compelling narrative, while extensive gallery sections present revealing and thought-provoking artworks by asylum patients and other artists from each era of the institution and beyond.

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chapter 1 the madhouse 18th century TWML_Chapter 1.indd 37 09/05/2016 12:3

The symbolism was impossible To ignore: a facade of care concealing a black hole of neglecT. The new Bethlem that arose in 1676 from the ashes of the Great Fire of London was hailed as one of the great ornaments of a city reinventing itself as the wonder of the age. London’s medieval warrens of wattle and timber were replaced with a theatre of the modern world: the fashionable residences and entertainments of the West End; the financial hub of the City, where commodities were traded across the globe; and a raffish Grub Street and coffeehouse scene, where gossip and subversive ideas circulated and the follies of the powerful were satirized. above Hospitium Mente Captorium Londinense (c. 1690). Engraving by Robert White, depicting the new Bethlem. of the Royal Society, rival of Isaac Newton and assistant to Christopher Wren – was commissioned to design a public hospital that was fitting for the new city. The result looked like no hospital in history. Its stone gates opened onto formal gardens with tree-lined, free-stone promenades, behind which rose an ornate facade modelled on Louis XIV’s Tuileries Palace in Paris, with Corinthian columns, royal arms carved in stone and swagged with garlands, and a central balustrade leading up to an octagonal turret crowned with a shining cupola. It was a spectacular gesture of reinvention, not only of London but also of madness itself. Bethlem had stood for so long as the only public institution for the mad that its gloomy, draughty cells had become synonymous with the misery of the condition. But the new building was the envy of the city. In the words of Bethlehems Beauty, Londons Charity, and the Cities Glory (1676), the first of many poetic effusions published after its opening, it ‘makes one Half-Madd to be a Lodger there’. The old Bethlem priory was not destroyed in the Great Fire but many of the governors’ residences were, and the staff used the hospital as temporary accommodation. A few winter nights demonstrated a fact that must have been obvious to Bethlem’s residents for centuries: with stone floors, no fireplaces and no windows, it was barely fit for human habitation. A new site was chosen at Moorfields, on the edge of the city, and the brilliant polymath Robert Hooke – stalwart TWML_Chapter 1.indd 38 09/05/2016 12:31 the madhouse

However, the face that the new Bethlem presented to the world was little more than a stage set. The building had no foundations: it had been erected on the waste ground beside the old Roman city wall, and six inches below ground its brick gave way to rubble. The weight of the facade bowed the flimsy structure behind it; the walls developed gaping cracks and ran with water whenever it rained. Before long, the chorus of praise for its grandeur was shadowed by jibes at its pretensions and paradoxes. ‘The outside is a perfect mockery to the inside,’ satirist Thomas Brown observed in 1699, making one wonder ‘whether the persons that ordered the building of it, or those that inhabit it, were the maddest’.1 Moreover, the symbolism was impossible to ignore: a facade of care concealing a black hole of neglect. It was a cruel but accurate reflection of the mixed motives that had led to Bethlem’s reinvention. The first examples of large-scale public madhouses had appeared earlier in the 17th century in the Dutch republics as expressions of civic pride in clean and orderly urban living. Known as dolhuizen, they were funded by public subscription, along with houses of correction for the idle and socially disruptive. In these buildings, work and discipline were the rule, and the mad were disruptive to the routine. The dolhuizen were humane and democratic in that they provided a place for those who would otherwise be abandoned on the street, left The Amsterdam dolhuis ,or madhouse, after the completion of its renovation and extension in 1617. left Relief depicting the dolhuis in ‘s-Hertogenbosch, by Pieter van Coeverden (1686) TWML_Chapter 1.indd 39 09/05/2016 12:31 the madhouse

A1. Bicêtre Asylum, Paris, France, 1642 B1. Hopital Royal de la Salpêtrière, Paris, France, 1656 A2. Dolhuis, Amsterdam, Holland, 1663 B2. Bethlem, Moorfields, London, 1676 A3. St Luke’s Lunatic Asylum, UK, 1751 B3. Der Narrenturm, Vienna, Austria, 1784 A4. Ticehurst House Hospital, UK, 1787 B4. York Retreat, UK, 1796 A5. New Bethlem, St George’s Fields, London, 1815 B5. Bloomingdale Insane Asylum, New York, 1821 A6. Lunatic Asylum, Brussels, Belgium, 1825 B6. Hanwell Asylum, UK, 1831 TWML_Chapter 1.indd 40 09/05/2016 12:3

C1. Hospital for the Insane, Philadelphia, USA, 1841 D1. Kissy Asylum, Sierra Leone, 1844 C2. Colney Hatch Lunatic Asylum, Southgate, UK, 1851 D2. Lunatic Asylum, Adelaide, Australia, 1852 C3. New York State Asylum for Idiots, Syracuse, USA, 1855 D3. Juvenile Asylum, New York, USA, 1856 C4. Finlay Asylum, Quebec, Canada, 1860 D4. Asylum for Criminal Lunatics, Broadmoor, UK, 1864 C5. Insane Asylum, Beechworth, Victoria, Australia, 1867 D5. Northern Hospital for the Insane, Illinois, USA, 1872 C6. Lawrence Asylum, India, 1873 D6. Branch Insane Asylum, Napa, California, USA, 1873 TWML_Chapter 1.indd 41 09/05/2016 12:3

but they also reflected a new intolerance for civil disorder. People wished for the mad to be treated humanely, but at the same time they believed that the less contact they had with others the better. The madhouse stood in clear contrast to the system that emerged under the French monarchy: in 1656 Louis XIV founded a state system of institutions known as hôpitals généraux, where the mad were confined alongside beggars, criminals, prostitutes and vagabonds. In Paris the new prisons included the Bicêtre and the Salpêtrière, which would eventually become the city’s two great magnificent frontage was invisible to those inside it, who were confined in two gloomy and crumbling galleries, for male and female inmates. The exterior advertised its charitable largesse to the new city, but also served to distract from the conditions in which its charges were locked away. The building’s signature, crowning the main gates, was a pair of statues by renowned Danish sculptor Caius Gabriel Cibber titled Raving and Melancholy Madness (1676). These hulking figures would remain a London landmark for generations, the faces of madness frozen in stone. Their expressions below (left and right) Engravings of the statues of Raving and Melancholy Madness, each reclining on one half of a pediment. asylums for men and women, respectively. Their purpose was simply to remove beggars and other public nuisances from the streets, which they did in numbers that eventually rose to around six thousand. A letter from the king was enough to confine anyone for life without right of appeal. Bethlem embodied the progressive sentiment that the mad were not to blame for their condition and should not be treated like criminals, but at the same time it was a pragmatic response to the disruption they caused in prisons and workhouses. Its and poses could be read in many ways: as cautionary examples, as objects of pity, as medical illustrations. The contrast between them illustrated a classical idea of madness and its physical roots: on the left the torpor caused by black bile, and on the right the frenzy produced by excess of blood. At the same time, they characterized the types who were most likely to find themselves confined in Bethlem: those whose behaviour was chaotic and violent, and those who were too withdrawn to engage with the world around them. From another viewpoint, TWML_Chapter 1.indd 42 09/05/2016 12:31 the madhouse

UnTil This poinT There had only been Two opTions for The mad: living wiTh Their families if They were lUcky, or roUgh on The roads if They were noT. above Engraving by Etienne-Jules Thierry, 1818, published in 1820. The plan of Paris indicates the locations of civil hospitals and homes. they epitomized the two problems that the madhouse had been built to address: the disruptive elements that needed to be isolated from civil society, and the demented or ‘mopish’ who were unable to contribute to the new economic order. Bethlem’s grandeur was also a response to the growth in private madhouses, a business sector that would become known in the 18th century as the ‘trade in lunacy’. The old hospital had held a virtual monopoly on the care of the mad, but now it was competing with fashionable and well-funded rivals. Up to this point, besides Bethlem, there had been only two alternatives for those afflicted with madness: living with their families if they were lucky, or rough on the roads if they were not. The growing middle class now had a third option within their means: boarding their distressed or unmanageable relatives in specialist houses where they could be cared for with others of their kind. Private madhouses tended to cluster together to share cleaners, nurses and medical staff; in London they were grouped in Chelsea to the west and Hackney to the east. They offered care that was beyond the reach of many families, especially the growing number obliged to choose between looking after their difficult relatives and earning money. The booming commercial worlds of trade, transport and craft guilds involved long hours of labour, travel and shift work, which loosened the ties of traditional family life. Bethlem’s magnificence was a statement of intent for London’s ambitions, but also an attempt to vault to the peak of this expanding market. In this it was relatively successful: the new hospital accepted fee paying patients, who soon made up around one-third of the intake. There are a few fragments of poetry written by Bethlem’s early inmates, but the voices of the mad in this era mostly issue TWML_Chapter 1.indd 43 09/05/2016 12:31 the madhouse

In these satirical works, quack doctors and itinerant surgeons operate on the mythical ‘stone offolly’. They are depicted extracting the stones from the heads of grimacing patients, symbolizing the expulsion of ‘folly’ (insanity). above (left) Photogravure, 1926 above (right) Engraving, 17th century. below Mezzotint, David Teniers. TWML_Chapter 1.indd 44 09/05/2016 12:3

above (top) Bloodletting, a humoral remedy for mania, by Diana Ghisi, 16th century. above A cupping scene in a German baths, by Alfred Martin, published in 1906. below (left) A seated man holds his arm out in preparation for bleeding, 1594. below (right) A caricature offemale barber surgeons bloodletting from a patient’s foot. TWML_Chapter 1.indd 45 09/05/2016 12:3

from The beginning, beThlem’s care of iTs inmaTes was sTreTched Thin. from private madhouses, and particularly in the form of protests by those who were forced into them against their will. The Vagrancy Acts of 1714 and 1744 made a formal distinction between lunatics and other undesirables: the mad were protected from the public whipping to which other classes were subject, but they could be locked up if two Justices of the Peace agreed that they were a public danger. The Acts said little, however, about their rights to be released, and the complaints of those detained maliciously, for revenge or financial gain, became a staple of the scandal sheets. The best remembered is by Alexander Cruden, a devout Presbyterian bookseller, subject to wild romantic infatuations, who was locked up several times in order to restrain him from pursuing his love objects. His pamphlet of 1739, The London Citizen Exceedingly Injured, details his various imprisonments and daring escapes, as well as his terror that he would end up in Bedlam, ‘the sorest evil that could befall him, and which he dreaded more than death’. After his release, Cruden continued to publish pamphlets under the nom de plume ‘Alexander the Corrector’, in which he condemned the immorality of public life and pointed out grammatical errors in street signs. He also wrote A Complete Concordance to the Holy Scriptures (1737), which has never been out of print since it was published. From the beginning, Bethlem’s care of its inmates was stretched thin. The galleries were staffed by attendants, uniformed in the blue coats of charity workers, who fed their charges on porridge, bread and cheese, with meat three times a week. The inmates were cleaned and dressed, shaved and bathed, and occasionally ministered to by a surgeon. They received no special therapy for their mental conditions but were given general treatment aimed at restoring a healthy balance to the constitution. Its right The Hospital for Lunatics (1789) by Thomas Rowlandson, in which the incurable patients are represented by political figures. TWML_Chapter 1.indd 46 09/05/2016 12:31 the madhouse

above (left and right) Etchings by John Thomas Smith, published in 1814. Two views of Bethlem hospital from the south and south west, with part of the London Wall. main features included bleeding – a seasonal practice, concentrated at the beginning and end of summer – purging with emetics and douching with cold showers. The rationale for these treatments drew on the prevailing doctrine of humours, according to which violent behaviour could be calmed by drawing blood and black moods relieved by vomiting up substances that were blocking the digestion. However, they could also be deployed for the benefit of the keepers, whose jobs were demanding and unrewarding. They were entrusted with a steadily growing population of troubled and troublesome inmates, most of whom had ended up in Bethlem because everyone else had found them to be unmanageable. These inmates suffered from a variety of untreatable disorders and had nothing to occupy them. The priority of the staff was to maintain order, and the medical regime was deployed to serve this purpose. Bleeding weakened the inmates and made them more tractable; like purging and cold baths, it could be withheld from well-behaved patients and threatened to keep disruptive ones in check. They were ‘treatment’ in the sense of punishment as much as cure. Pressure on resources led Bethlem to institute the policy that defines it in the public imagination to this day. With the charity of London’s great and good spread among ever more worthy causes, and income from paying guests limited by the grim reputation that had so terrified Cruden, the governors decided to install donation boxes at the entrance of the new building and to open it for public visits. Londoners thronged to the new attraction: it joined a tourist trail that included the Tower...

Table of contents

• Introduction
• 1. The Madhouse
• 2. The Lunatic Asylum
• 3. The Mental Hospital
• 4. Beyond the Asylum
• Sources & Further Reading
• Index
• Sources of Illustrations
• Acknowledgments