The History of Bethlem

Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker, Keir Waddington

• Publisher: Routledge
• Year: 2013
• Print ISBN: 9780415017732
• eBook ISBN: 9781136098604
• Topic: History
• Subtopic: World History
• Index: History

Bethlem Hospital, popularly known as "Bedlam", is a unique institution. Now seven hundred and fifty years old, it has been continuously involved in the care of the mentally ill in London since at least the 1400s. As such it has a strong claim to be the oldest foundation in Europe with an unbroken history of sheltering and treating the mentally disturbed. During this time, Bethlem has transcended locality to become not only a national and international institution, but in many ways, a cultural and literary myth.
The History of Bethlem is a scholarly history of this key establishment by distinguished authors, including Asa Briggs and Roy Porter. Based upon extensive research of the hospital's archives, the book looks at Bethlem's role within the caring institutions of London and Britain, and provides a long overdue re-evaluation of its place in the history of psychiatry.

CHAPTER ONE

INTRODUCTION

Bethlem is a unique institution. Now seven hundred and fifty years old, it has been continuously involved in the care of the mentally ill since at least the 1400s — in other words for nearly six hundred years. As such it has a strong claim to be the oldest foundation in Europe with an unbroken history of sheltering and treating the mentally disturbed. Facilities for the mad were set up in Spain from the early fifteenth century, beginning in Valencia in 1409, but such establishments were not to enjoy a continuous thread. In most of Western Europe it was the sixteenth century which brought comparable developments, and some regions did not develop independent psychiatric facilities until the nineteenth century. Many medieval institutions housed mad people from time to time, but few specialized in their care and won a reputation for it.¹

Bethlem is not simply Europe’s oldest psychiatric establishment; it is the most famous — or, what for long amounted to the same thing, the most notorious. Certain psychiatric hospitals were to achieve prominence within the profession — the York Retreat, or Illenau in the German state of Baden, both in their distinctive ways regarded as model environments at particular moments in the evolution of psychiatry. Some have provided the stage for dramatic episodes in the history of psychiatry- for instance Bicêtre in Paris, where Philippe Pinel supposedly struck the chains off the lunatics in a magnificent emancipatory gesture during the French Revolution.² Others, so to speak, had greatness thrust upon them because of the illustrious patients who happened to have been detained there — the name of Charenton is now indelibly printed upon the public mind thanks to its association with the Marquis de Sade. Nevertheless, it is arguably only the name of Bethlem that has actually turned into everyday speech and become part of a national culture. In English parlance ‘Bedlam’ — as in ‘Bedlam mad’ or later expressions like ‘utter bedlam’ — was becoming, from around Shakespeare’s time, detached from the institution and assuming a life and a persona of its own, with connotations of turmoil, confusion and cacophony. It was perfecdy natural in the early years of the Industrial Revolution for a blast-furnace in the West Midlands — well over a hundred miles away from Bethlem Hospital itself— to be christened ‘Bedlam’, just as it is still utterly natural to speak, for example, of the rush-hour or the January sales as being ‘like Bedlam’.³ While English-speakers give these usages no hought, it is interesting that equivalent sayings barely exist as commonplaces in any other language or culture. A resident of Berlin, Bordeaux or Boston can of course speak colloquially of someone being about to be packed off to this or that local asylum, but that is the point: it seems that only Bethlem transcended locality and became a ‘national institution’ — in both senses of that term.

Indeed, more than national — international. For over a century Bethlem was one of the sights of London on any serious tourist’s itinerary, along with the Tower and Westminster Abbey; and it is easy to find examples of eighteenth- and nineteenthcentury continental psychiatrists invoking the example of the Hospital, mainly in a positive light and often as part of a propaganda campaign to encourage their own prince or burgermasters to endow a comparably imposing establishment.

Given that Bethlem became a national institution — indeed became Bedlam — it is very odd that its history has been so little studied and that beyond a limited repertoire of lurid incidents, so little is known about its real history. Its archivist, Patricia Allderidge, has offered a plausible explanation for this: ‘historians of psychiatry’, she has observed, ‘actually do not want to know about Bethlem as a historical fact because Bethlem as a reach-me-down cliché is far more useful. It has, after all, fulfilled this role in the popular imagination throughout much of its existence’. There is, in other words, an assumption that the truth about Bethlem is, somehow, almost instinctively too familiar to need any real investigation — and that goes with the supposition that all the hand-me-down tales must somehow be true otherwise they wouldn’t be so widely in circulation.⁴

Dangers lurk here. In the Middle Ages everyone knew that the Jews poisoned the wells, thus causing the Black Death. In the early modern period everyone knew that witches went off on their orgiastic sabbaths with Satan;⁵ under the ancien régime everyone knew the Bastille was crammed with political prisoners, oppressed by torture and torments. And in much the same way every schoolperson proverbially knows that Bethlem was a scandalous hellhole that systematically neglected its patients and, when it was not neglecting them, inflicted upon them cruel and unnatural therapies. Ten years back, as Allderidge also noted, a reviewer wrote of Bethlem’s staff that ‘they did not even pretend to offer either refuge, good care, or cure’: a statement at first blush so bizarre — a hospital that didn’t even pretend to look after its patients? — that it could only have been written in the unspoken belief that nothing could be too bad to say about the Hospital.

All sorts of pseudo-facts reinforce the ‘bad Bethlem’ myth. Take sightseeing; that was indeed openly permitted back in the seventeenth and eighteenth centuries, as is documented below in Chapter 13 — in 1610 Lord Percy recorded going to see the lions in the Tower, the show of Bethlem, and the fireworks at the Artillery Gardens. In those days there was nothing odd about permitting or encouraging such a spectacle: all the world was a stage and visiting Bethlem was regarded as edifying for the same reasons as attending hangings. But distinguished scholars have taken this one stage further and computed that in the seventeenth century the hospital entertained as many as 96,000 visitors a year. Here, as Allderidge has pointed out, we must pause. How do we know? There were no turnstiles or visitors’ books. It’s a figure arrived at by some foolish deductions from the finances — inflated to absurd proportions, one suspects, so as to highlight the sense of freakshow. The result is that such facts become articles of faith, repeated like mantras, from one book to another. Very recently the following appeared:

As late as 1815, the Bethlehem madhouse exhibited lunatics every Sunday, admission one penny. The annual revenue from these visits amounted to £400, which amounts to an astonishing 96,000 admissions a year.⁶

Not one single ‘fact’ in that statement happens to be factual.

It is particularly intriguing that little serious historical investigation has been conducted into Bethlem, given that histories of Bethlem actually started very early — over two hundred years ago, which is, of course, long before most asylums were founded let alone acquired a history that could be written up. In 1783 there appeared An Historical Account of the Origin, Progress and Present State of Bethlem Hospital, penned by the Revd Thomas Bowen, who was the chaplain to Bridewell (see Chapter 20). This was, however, less a real history than the Georgian version of a glossy promotional coffee-table work, a public-relations exercise setting Bethlem in a shining light for fund-raising purposes.⁷

The first full-length history was the work of a Bethlem chaplain, the Revd Edward O’Donoghue, whose The Story of Bethlehem Hospital from its Foundation in 1247 came out in 1914, was never reprinted, and so is rather rare.⁸ O’Donoghue was a quirky and superstitious man. A one-time member of the Charity Organization Society, he was a sympathetic listener and friend of the patients and a keen journalist who played a major role in keeping the Hospital’s journal going.

His Story of Bethlehem is a curiosity, written in a style by turns affected, archaic, chatty and condescending; the historian takes sides, turns history into a pageant of saints and sinners, parades his whimsical prejudices and comes up with some bizarre speculations. Yet, while largely neglecting the institution’s later records, his work had the very real merit of delving into the early archival sources, casting light on much that had been quite obscure. The Governors, rather than have the murkier episodes of its history raked over yet again, wanted generally to let sleeping dogs lie. Although they judged the book unsuitable to be given to the patients, they did order some 2,000 copies for distribution.

Perhaps because of the existence of O’Donoghue’s leisurely look at the byways of Bethlem, its history then attracted virtually no attention for half a century, though a pot-boiling and often inaccurate book came out in 1972,⁹ and growing attention was paid to Bethlem’s image by literary scholars, for instance by R. R. Reed in his Bedlam on the Jacobean Stage.¹⁰ During the last twenty years Patricia Allderidge has herself published a number of original and challenging articles, both debunking old Bethlem myths and exploring aspects of its history, and Jonathan Andrews has produced a doctoral dissertation covering the years 1634 to 1770, strongly arguing that the time is long overdue for a serious re-evaluation. David Russell’s Scenes from Bedlam has developed these ideas, focusing on patients and their carers from the mid-sixteenth century. While he does not attempt to write a history of Bethlem he does give a broad overview, although less is said about Bethlem in the twentieth century where the focus is on the Maudsley, training and research.¹¹ Yet, despite the fact that British psychiatry without Bethlem is like Hamlet without the mad prince, Bethlem has remained essentially ignored.

Psychiatry’s history has enjoyed a remarkable surge of interest in the last couple of decades — in part due to the intense public debates over the state of psychiatry itself and particularly the future and fate of psychiatric institutions.¹² Professional historians have argued that psychiatric history as traditionally written by (practising or retired) psychiatrists has tended to be Whiggish’, that is to say anachronistic and triumphalist, interpreting and judging the past in terms of the present, and complacendy taking for granted a tale of progress; psychiatrists have countered that such revisionist or radical historians are no less anachronistically judgmental in their often highly critical stance. Such debates continue to rage, and doubdess the information provided by this book might be used to lend support to either side.¹³

But it is important to stress at the outset that current historical controversies respecting psychiatric hospitals since around 1800 — questions of institutionalization and subsequent deinstitutionalization — are not, and should not be central to this history of Bethlem. That is to some degree because Bethlem was not, of course, founded as a lunatic asylum. During its first century it had no deranged people at all; and at least till the Reformation it served a variety of other purposes as well as giving shelter to the mad. It is also because, even with respect to the insane, Bethlem does not fit into the patterns standardly visible elsewhere. True, since around 1850 Bethlem has in most ways integrated itself within the British psychiatric world, yet major differences remained; while many public institutions were growing huge, housing thousands of patients, Bethlem stayed very small indeed.

The history of a typical British lunatic asylum or psychiatric history might run like this. Mumerset County Asylum was founded in the first half of the nineteenth century in response to the stresses and strains of an urbanizing society with a rapidly rising population; the medical profession gradually imposed its authority on the institution — even their vision of what asylums ‘ought to be’, to borrow part of the tide of Dr W A. F. Browne’s early-Victorian book.¹⁴ The asylum rose in prominence, it grew in numbers of inmates, and daunting problems emerged, including the counter-productive effects of institutionalization and expansion themselves. Stagnation followed in the latter part of the nineteenth century, punctuated after the First World War by intermittent attempts at reform, with attempts to integrate it better within the community, leading perhaps, as a result of internal and external pressures, to closure in the late 1980s.¹⁵

If this thumbnail sketch might serve as a recognizable asylum profile, the crucial point is that Bethlem corresponds to it in almost no respect at all. It would be poindess to recite at this juncture all the ways in which Bethlem breaks the mould — that is one of the aims of the body of the book. The point is not simply one of its exceptional longevity — of the fact that Bethlem has a past that long antedates the average private asylum or county asylum, and hence established traditions of its own and carved out a unique niche for itself within the ‘trade in lunacy’.¹⁶ It is also that even during the nineteenth and twentieth centuries Bethlem was often conspicuous in its attempts to be distinctive from and independent of other institutions. This is a path it has followed with considerable success; in an age in which many institutions have closed down, Bethlem is very much alive and well — and growing. There are clichés about Bethlem which may be confirmed by the research set out in this book; but few stereotypes about asylums in general apply to Bethlem.

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Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of plates
• List of figures
• List of tables
• Acknowledgments
• List of abbreviations
• 1 Introduction
• Part I: 1247–1633
• Part II: 1633–1783
• Part III: 1783–1900
• Part IV: 1900 to the present
• Part V: Appendices
• Name index
• Subject index