Today, the Bethlem Royal Hospital in London is a modern psychiatric hospital. But if you were unlucky enough to be sent there in its earlier days, you would know why its name, even today, is synonymous with chaos and madness.
Bethlem Hospital (quickly shortened to ‘Bedlam’) was Europe’s first insane asylum. Founded by the church as an almshouse in 1247, it became the first institution to attempt to treat the insane in 1357. Italian Bishop Goffredo de Prefetti first established the facility which was meant to help raise money for the Crusades through alms collection. However, it wasn’t uncommon during the time for religious figures to take in the indigent—who were (and are still) often mentally ill. It is unclear when the facility’s focus shifted exclusively to treating the mentally ill, but by 1330 it was referred to as a hospital, and by 1377 it was known primarily as a home to the insane. Bedlam has now been home to the mentally unwell for over six centuries. But for nearly all of those years, its inmates survived in conditions of almost unimaginable horror, filth, and abuse.
A report from the 1600s found the sewer below the building was constantly blocked, with filth piling up at the entrances. There was no connection at the time between health and hygiene, and water had to be hand carried, so even regular hospitals were filthy, and Bedlam was worse.
People with illnesses that we now recognize as schizophrenia, depression, autism, and epilepsy might all have found themselves in Bedlam.
By the late 1600s, the deep need for a remodel had been recognized–although not to improve the services rendered. Instead, the hospital was rebuilt on grounds just outside of the city with an eye to the look of the asylum. Without public funding, it was necessary that the hospital show itself as a home of charity and assistance, even if that appearance was only that, an appearance.
Bedlam's new design came from Robert Hooke, a City Surveyor, and included Corinthian columns and a cupola-topped turret. The façade was inspired by Louis XIV’s Tuileries Palace in Paris. It also overlooked formal gardens with tree-lined promenades. However, the inside of the hospital displayed itself for what it truly was: broken. The beautiful ornate exterior was far too heavy, causing the back of the building to crack. The walls ran with water whenever it rained. Built on rubble, the foundations of Bedlam soon began to collapse as well.
It is also during the 17th century that the infamous asylum began to inspire numerous Jacobean dramas and ballads. The hospital was used to explore the meaning of insanity and sanity and who had the power to decide. In The Honest Whore, Part I, Bedlam was first used as a stage setting.
As the best known and largest asylum, Bedlam's reputation as a hell hole became a self-fulfilling prophecy. The more infamy it accrued, the worse conditions would get.
James Monro became Bethlem’s chief physician in 1728; his family would control the asylum for over the next four generations and 125 years. Under the family’s management, treatment worsened drastically as they shifted their methods from that of apothecaries' ideas and treatments to surgeons'.
Many patients were frequently beaten, starved, and dunked in ice cold baths. The dietary provisions of the patients were inadequate as many suffered from either starvation or malnourishment. Governors failed to provide hearty meals for patients, often relying on the gifts of basic provisions and the resources that were available to the steward to purchase. Patients were fed twice a day on a plain and reduced diet—it reflected the humoral theory that believed rationing diets and the avoidance of rich foods would allow the insane to restore the body to balance and restrain the spirits.
The facility originally opened its doors to the public with the hope to draw in family members to visit their loved ones. Unfortunately, it was unsuccessful in drawing in family... although it certainly grabbed the attention of wealthy Londoners. Worst of all, their suffering was entertainment for the rest of London. Although it cannot be confirmed, it is widely speculated that the decision to open the hospital to the public was motivated by the need to raise funds. At 10 shillings a pop (a suggested donation, naturally), the tours could soon prove lucrative. The inmates were put on display, their bizarre behavior and often cruel ‘treatment’ considered a form of theater. Ladies in fine gowns with handkerchiefs in front of their noses toured the halls as we might visit a House of Horror.
Inmates considered dangerous were permanently chained. Others were free to wander around. Manacles, confinement in tiny cages, immersion in icy water—all were tried as cures for mental diseases. So were starvation, bloodletting, beatings and isolation. ‘Rotational’ therapy involved spinning a patient in a chair suspended from the ceiling until they vomited. Many patients who might have survived their illness died from the therapy. In fact, patients who were considered too frail to survive the treatment were turned away.
As long as the Munro family continued their reign over the Bedlam hospital, the atrocities continued. The final Munro superintendent was Thomas Munro. In 1816, he resigned after a scandal, which culminated in an accusation that he was "wanting in humanity" for the patients of Bedlam. After the departure of Munro, the hospital began to move forward into more modern, less exploitative methods of treatment of mental illness.
Of course, even into the 1960s, our ‘modern’ treatment for mental illness included things we now consider barbaric like padded cells, straitjackets and lobotomies. And even a contemporary psychiatric hospital can be a grim place to visit.
But the misery and the shame of Bedlam Hospital is now gone, with only the word to remind us how it was.
Featured photo: Wikimedia Commons