On Wednesday I made a brief mention of the number of private Madhouses* in Hackney, Hoxton and Bethnal Green. I'll do a separate post on those another time, but today I just want to tackle the thorny subject of Bethlem Hospital (in its Georgian incarnation), and the treatment of the insane in Georgian London.
Bethlem Hospital, nicknamed Bedlam from its earliest times, is the oldest hospital in the world to deal specifically with mental disturbance. It has lived in four places since it took in its first mentally ill patients in 1357: in an old priory where Liverpool Street Station is now, Moorfields and Southwark and now Beckenham. I am most concerned with the Moorfields site, the first of three later purpose-built hospitals. Whilst the priory with its individual cells had originally been useful for confining inmates separately, it was over subscribed and in a poor state of repair. The new building, designed by Robert Hooke, was built at the Southern edge of Moorfields. It was a huge, grand building (that would later prove structurally unsound) and included the Caius Gabriel Cibber sculptures of 'Raving and Melancholy Madness' (now in the V&A). These sculptures signified the distinction made at the time between insanity (incurables) and depression (curables). Those born with severe mental deficiency, but largely passive natures were classed as idiots*. Samuel Johnson and Fanny Burney had a conversation about madness (mainly Johnson's fear of it) and how he believed it to come about through disconnected thinking, and how she believed it to be the result of a breakdown when life was very cruel and burdensome. 'Moral insanity' which one hears bandied about so much was a blanket term and it didn't mean 'you are a bad person and it has sent you mad', it means 'you have syphilis, or have lost your mind because of vile experiences as a street prostitute, or through drug abuse, and are therefore insane, and this is an acceptable euphemism'.
Very briefly, the care an afflicted person could expect to receive depended then, as now, on how much money they had. Bedlam was for poor people, which is why large numbers of official documents pertain to it. If you had a relative or spouse who became mentally ill, or was born an idiot (they managed to marry remarkably often if they had a large amount of land or money) you could have them nursed at home. If they became violent, you could have them cared for in an private madhouse. If you had nothing and were likely to end up on the street or in the workhouse, you went to Bedlam. The criminally insane such as Margaret Nicholson, who attempted to stab George IIIrd were also confined there. The engravings of the new hospital show it was built on no mean scale, and looks far more like a sanctuary than a prison. Hooke's plans show a distinct care for space, light and recreational areas for the patients.
From its opening in 1676, tours of the new building could be had for a penny a time. That people came and poked the insane with sticks is unlikely, but they did come to watch the 'ravers', particular favourites being the compulsive masturbators of both sexes. In no way do I condone making a spectacle of mental illness, but if asylums were open for visiting today people would go and gawp, so to condemn the Georgians as cruel is hypocritical considering the number of websites and magazines devoted to the bizarre and unfortunate of every kind. It should also be noted that one cannot take too much notice of Mr Hogarth's paintings and engravings on such subjects. He was a notorious joker (note how the Rake is depicted in the posture and appearance of Cibber's 'Raving Madness') In 1770, the visits were stopped, being considered inhumane.
In 1774 the Madhouses Act was passed in an attempt to improve the lot of those consigned to these institutions. It was largely unsuccessful, but excellent private houses did exist (and terrible ones, to be posted on some time in the near future), and the Monro family of doctors did take action to improve care at Bedlam in over a century of medical attendance there. Although many of their ideas were antiquated, they were concerned with exchanging shackles for straight-jackets, fitting cork or india-rubber flooring to cells, recreational activities, good diet and exercise for those who could take it. It is unclear how many patients were there at a time, but the numbers indicate above two hundred, plus around 80 criminally insane prisoners who were kept separately. Exceptionally violent or criminally insane patients were still kept fettered and in some cases wearing only blanket tunics and if they continued to soil bedding were given only straw to sleep upon. Almost every patient had a carer, but men were sometimes put in charge of female patients and there were accusations of abuse.
It cannot be assumed that everyone in Bedlam was an incoherent lunatic*. There were inmates who were both lucid and persuasive, such as James Tilly Matthews, admitted in 1797, who is believed to be the first fully documented case of paranoid schizophrenia. Tilly Matthews was a Welsh tea merchant who became obsessed with the idea that a gang of espionage 'experts' had set up a magnetic 'Air Loom' at London Wall, and were brainwashing the citizens of London, including major politicians. He spoke of threatening and harming these 'infected' persons. John Haslam, Bethlem's resident apothecary studied Tilly Matthews and made drawings of this loom (in the gallery). As a patient, Tilly Matthews was charming, but he was kept in an institution for the rest of his life.
In 1799, the building began to subside, and it was decided that it should be moved to Southwark. It took until 1815 to happen and the old hospital was demolished. With the turn of the 18th century, care for the mentally ill entered a new phase, much more like the care we see today and attitudes towards the afflicted changed rapidly. Bedlam is perhaps the worst example of early psychiatric care (we will never know the worst abuses in the private madhouses), and it was rapidly outpaced by the new-fangled St Luke's, under the charge of William Battie, which opened opposite it in 1751. However, it has retained its original purpose into the present day, and continues to provide care under very difficult circumstances.
*All these were the accepted terms in the period, although they are now antiquated and in many cases, inappropriate.
