The word bedlam, meaning uproar and confusion, is derived from the hospital's prior 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, hence the modern definition of "bedlam".
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 Bishopgate (where Liverpool Street station now stands). In 1337 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.
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 by Robert 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."
The inmates 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. Entry was free on the first Tuesday of the month. In 1814 alone, there were 96,000 such visits.
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 James Lewis (a cupola was added later by Sydney Smirke). The inmates were referred to as "unfortunates" and must have had an uncomfortable time in their first winter there; no glass was initially provided for the windows, because of "the disagreable effluvias peculiar to all madhouses". In June 1816 Thomas Monro, Principal Physician resigned as a result of scandal when he was accused of ‘wanting in humanity’ towards his patients.
The Benjamin Rush Chair or Restraining Chair was also used to limit motion and reduce sensory stimulation by covering the head and blocking vision.
The new 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. The old hospital and its grounds were bought by Lord Rothermere and presented to the London County Council for use as a park; the central part of the building was retained and became home to the Imperial War Museum in 1936.
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 Psychiatric survivors 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 earlier Bedlam site at the Imperial War Museum. The historian Roy Porter called the Bethlem Hospital "a symbol for man's inhumanity to man, for callousness and cruelty."
Seclusion in its worst form is the Wooden Crib or Restraining Bed. This is a form of containment in which you can see that person is totally strapped into a crib with no way to move.
In a report to the House of Commons in 1815. Dr. Connoly reported that he found in one of the side-rooms; "about ten patients each chained by one arm or leg to the wall, each wearing a sort of dressing gown with nothing to fasten it. Some sensible and accomplished, some imbeciles. Many women were locked up naked with only one blanket." One inmate was chained to her bed for eight years, the matron feeling the prisoner would murder her if released. When finally the date of her release arrived she became tranquil, nursing two dolls which she imagined were her children. Another patient, well-known to the many visitors, wore a straw cap and promised to declare war on the stars if rewarded with a bottle of wine. One of the most famous patients, often visited by members of Parliament was a certain William Morris. For twelve years he was chained with a strong iron ring round his neck His arms were pinioned by an iron bar and he could only move twelve feet away from the wall. In this position he lived as normal a life as possible before dying shortly after his release.Two more patients spent a total of over eighty years between them in Bedlam for trying to kill the same man. James Hadfield was confined for 39 years for attempting to shoot George III. He spent his time writing verses on the deaths of his cats and birds, his only companions in the hospital. Margaret Nicholson spent 42 years in solitary confinement for attempting to stab the same King.
William Morris, chained in Bedlam
William Cooper desribed his thoughts on visiting the asylum as a youngster,
"The madness of some of them has such a humorous air, and displayed itself in so many whimsical freaks, that it was impossible not to be entertained at the same time that I was angry with myself for being so."
The life stories of some of the patients who finished their days in Bedlam make fascinating reading.
Hannah Hyson died within days of being rescued by her father from Bethlem, her body covered in scabs and her knuckles red raw where she had crawled about her cell on her hands and knees.
Ann Morley, a former patient at Bethlem, was admitted to Northampton Asylum in a skeletally weak condition, incontinent, prolapsed and close to death. Upon recovery, she testified to being punched in the face by a bad-tempered nurse called Black Sall (the name referred to Sall's moods), hosed down with freezing water and being made to sleep naked on straw in a cellar.
Here are pictures of an early version of the straightjacket itself, a chair incorporating a straightjacket restraint, and another commonly used psychiatric restraint.
It was only with the arrival of William Charles Hood, in 1853, that Bethlem began its long process of reform, and even after this date episodes of cruelty and neglect surfaced, with a high suicide rate attracting press coverage in the 1880s.
Many authors and poets have written about Bedlam including Charles Dickens, Selected Journalism 1850-1870, in which he compares the thoughts of the insane with our own thoughts whilst dreaming. He wrote: "I wonder what the great master who knew everything, when he called Sleep the death of each day's life, did not call Dreams the insanity of each day's sanity".
Other noteable patients
- Lemuel Francis Abbott, portrait painter
- Richard Dadd, artisit
- John Frith, would-be assailant of King George III
- Daniel M'Naghten, catalyst for the creation of the M'Naghten Rules (criteria for the defence of insanity the in the British legal system) after the shooting of Edward Drummond
- Jonathan Martin, the man who set fire to York Minster.
- James Tilly Matthews, one time tea merchant and subject of the first book-length psychiatric case study
- Moll Cutpurse, also known as Mary Frith or "The Roaring Girl", released from Bedlam in 1644 according to Bridewell records
- Margaret Nicholson, would-be assassin of King George III
- Edward Oxford, tried for high treason after the attempted assassination of Queen Victoria and Prince Albert
- Martha Thompson, Methodist convert
- Louis Wain, artist