Strange Places Bethlem Hospital
Hello John here and I’m at one of the most historically significant mental health hospitals
in the English speaking world with a history of over 700 years, I’m also kicking off
a revival of an old plainly difficult series, strange places, well it's cold today so without
any more delay back to John in the studio.
It is 1946 and a brilliant atmospheric B Movie horror, will go on to lose RKO money at the
box offices, the movie is called Bedlam, and it is set in a fictionalised mental asylum
based on one of many of british society's fears of going to bethlem hospital.
The hospital would become the very name to describe madness and chaos, weaving itself
into the fabric of popular culture with countless poems, dramas and literature works inspired
by the institute.
For those who entered many never returned, the hospital represented a dumping ground
for some, tourcher for many and a caring institute of treatment for others.
The location of this hospital would change several times with each move the method of
treatment would also develop from essentially locking people away to a more human approach
to mental health.
This Strange Places History spans all the way back to the high middle ages today we
are going to peek into Bethlem Hospitals past welcome Strange Places, a Revived Plainly
Difficult series.
Mental Health is a story as old as time, so long as we've had brains we have been susceptible
to disease and disorder.
Needless to say the way Humans have dealt with mental health conditions have varied
throughout the years, often written off mental disorders were considered the work of the
devil , and as such those afflicted were ostracised.
Throughout almost all of human history we have had to ponder the question what to do
with those in society who struggled with ale-ments of the mind.
But although bethlams history is intertwined with the treatment and containment of the
mentally ill, the hospital's beginnings were very much different.
Early Beginnings
Our story starts in the year 1247 in the city of London, specifically Bishopsgate, which
is around here on an ancient map and is kind of near the location of modern day liverpool
street station.
Goffredo de Prefetti the bishop elect of bethlehem was given a piece of land for the use of collecting
alms, basically money and material donations for the Crusades, it was obedient to the Church
of Bethlehem, and along with taking collections it would house the needy.
In mediaeval parlance the priory would be considered a hospital, but this is pretty
different to the modern interpretation of the word.
It was pretty much a charity home for the poor, ill and needy, as we know hospitals
would end up focusing more on the ill as time went on, but in this period of mediaeval history
it was just a form of religious housing.
As such because of the affiliation all who stayed had to have a yellow star sewn onto
their clothes, to represent the star of bethlehem.
St Mary of Bethlehem as it was known would gradually lose its affiliation to the bethlehem
order, and as such the priory sought protection from the city of london in 1346 where the
hospital became vulnerable to seizure under the reign of Edward III, where buildings owned
by foreign religious organisations were ripe for the picking by the crown.
This was kind of linked to Us english loving a fight with the French during the 100 years
war.
At some point along the way the hospital would lose its original name, being called Bethlam,
which was pretty much a bastardisation of BEthlehem, as is all too common in the English
language where words mould into something new over time.
Anyways, I'll fast forward a little bit though history, and 1403 with the hospital's first
officially recognised mental health patients, a charity commissioner noted on a visit of
six male inmates who were "mente capti", roughly translated from latin to english as caught
in the mind.
I don't know about you but to me that sounds like someone who has become withdrawn, obviously
this is open to interpretation, but because of the hospital's future purpose its possible
that these 6 men were the first at bethlem.
Interestingly some other items were recorded at this visit which also points to at least
the hospitals needing to restrain an individual; were f​​our pairs of manacles, chains,
six locks and two stocks.
By now the hospital site was a single storey building, covering just two acres, in the
centre of the courtyard was a chapel, and the hospital had 12 'cells' for patients,
a kitchen, staff accommodation and an exercise yard.
But sadly there wasn't much in the form of treatment for the hospital's inmates, due
to the religious links there was a lot of bible reading and looking for the sin that
caused the condition.
It was thought that corporal punishment could cure some conditions, while isolation was
thought to help a person 'come to their senses'.
Ok I’m going to fast forward a little more here, to one of the hospital's noteable keeper-physicians
in 1619, because this is the first hint that the attitude was starting to form that the
mentally ill need specialist care.
Helkiah Crooke was appointed under the encouragement of James VI and I, he was a specialist of
sorts and much more qualified than his predecessors who were largely skilled in everything but
medicine, with one being a cloth maker before his 19 year tenure as the Keeper Physicians.
But Crooke was different, he had a couple of years earlier released a hugely successful
book Mikrokosmographia which looked at the human body, with some rather graphic imagery.
But although on the face of it looking like a step in the right direction like his book
which has been thought of largely being plagiarised from other sources, quickly accusations of
corruption landed at his feet, and in 1632 an inquiry was held which amongst others had
him investigated for failing to feed the patients.
You see, a job like Crookes’s was largely seen as a cash cow to extort the patients
and the wider public, leading to many keepers being accused of corruption.
The location of the hospital over a sewer led to bethlem being seen as a dirty place
as it was known for regularly overflowing into the courtyard.
The hospital became widely seen as a place of pain with contemporary descriptions of
the noises that emanate from Bethlhem as "cryings, screechings, roarings, brawlings, shaking
of chaines, swearings, frettings, chaffings".
Just 2 years after Crookes’s inquiry and the hangover that it caused led the Hospital
to be moved to a more modern management structure.
The hospital took on a three level medical regime made up of a non-resident physician,
a visiting surgeon and an apothecary.
But although taking a more modern approach the hospital in its original form outside
bishopsgate was drawing to an end, and it would mark the first of its many changes of
venue.
Move 1 bishopsgate to moorfields.
At 400 years old the original hospital was showing its age, being described as "very
olde, weake & ruinous and too small and straight for keeping the greater numb[e]r of lunaticks
therein at present"
Although having enough space for 59 patients the writing was on the wall time to move somewhere
more appropriate and hopefully with fresher air.
Construction of the new hospital at moorfields which is around here on a map, began in 1675
and was completed just a year later, and this was no mean feat just look at the building
that resulted.
Designed by robert hooke the new hospital was a large imposing building, the grand appearance
was a kind of statement to the donors who had given money for the moorfields site, showing
success, it also acted as a billboard for more charitable payments.
Don't forget this was pre public funding of medical institutions and as such income was
mainly from donations with patients fees only covering a small amount of the cost of operation.
The hospital was rather hard to ignore and its new bigger size allowed more visitors
to view the building as well as accommodate more patients, this would be the beginning
of its entry into infamy.
But although the building looked something of a palace from the outside, on the inside
life was tough, it had been built on poor foundations and as such the building's grand
and heavy facade pulled away from the walls causing them to crack allowing the elements
into its long galleries and cells.
It was rather like putting lipstick ion a pig.
Strangely Bethlhem was best known for allowing public and casual visitors with no connection
to the inmates to visit and view the patients.
Visitors were allowed to gorp and rubberneck those who called it home, this was used as
a method of raising funds, one visitor would comment "thou shalt in Bedleem see one laugh
at the knocking of his head against a post".
This public spectacle allowed playwrights to visit who would later use their experiences
and the experiences of others from the hospital, in a number of plays in which actors would
tread the boards of The Curtain and The Theatre, two of London's biggest playhouses.
This helped further imprint the hospital into the british psychic, as such the name would
take another bastardisation from bethlehem to bethlem to Bedlam, an english shorthand
for mayhem or confusion.
Here is an example, Wetherspoons was bedlam last night when they sold out of carling.
Difficult patients were often called ‘stark Bedlam mad’.
The hospital's treatment would take a dark turn in 1728 whenJames Monro took over as
the chief physician he thought treatment should involve beatings, starvation, and dunkings
in ice baths.
This would mark the beginnings of the 125-year Monro family dynasty at bethlem arguably some
of the darkest times for the hospital.
As the 18th century progressed, the straight jacket made its way onto the scene, and were
used to restrain the patient whilst they were force fed laxatives into order to quite literally
expel any bad thoughts from the body.
Another rather popular treatment was bleeding and leaching, where incisions were made in
the patient's body to allow the blood to flow.
Treatment still focused around restraint, and punishment for patients behaviour, but
the hospital would yet again be set for a move.
A survey Undertaken in 1791 would confirm the already apparent poor state of the building,
when the governors were slapped with a £8,660 bill for repair.
This went largely ignored, necessitating another report in 1799, which deemed the building
much like how the patients had been, incurable.
In 1803 the governors finally agreed on a project of rebuilding on a new site, and thus
another move was required.
Move 2 St Georges Fields.
Now if you've done a tour of london's greatest museums you may have actually been to bethlem
hospital without even knowing it…
But ill tell you why in a bit.
But a new hospital was yet to be built and the moorfields site was outright dangerous
in parts, as such patients were transferred to smaller hospitals reducing the population
from 266 in 1800 to 119 in 1814.
Parliament agreed to provide £10,000 for the fund for a new hospital however this came
with a caveat that the Bethlem Governors would provide accommodation for any soldiers or
sailors of the Napolionic wars that had been deemed lunatics.
Fair deal I suppose, a sight was agreed upon in st georges fields, in southwark, south
london, just a stone's throw away from elephant and castle.
The new building was in the neoclassical style relying heavily on Hooke's original plan,
the new architect James lewis ditched the opulent facade in favour of a far more functional
and medicinal appearance.
The hos[ital would be completed in 1815 after 3 years of construction, with the first 122
patients arriving in August.
And over the coming years the building would get overcrowded, necessitating extra buildings
to the szite.
Attitudes had begun to move on from punishment to treatment at other asylums such as at the
Quaker-run York Retreat, but Bethlem held onto the old method of restraint and religious
coercion.
Bethlem operated largely without any outside inspections during the early part of the 19th
century, but external oversight was eventually inevitable.
This came along in 1853, when Bethlem's exemption from outside inspection ended.
The last of the Monroe dynasty, Edward Thomas Monro had left in 1852, heralding the era
of the resident physician.
With the departure of Monroe the hospital's treatment started to move towards non restraint
for the average patient this was known as moral treatment, outpatient treatment began
creating the first such method of care in the UK.
But be under no illusion that it was a treatment utopia, although better than just straight
up torcher, treatment was still pretty harsh, by today's standards.
Patients were often classified as Idiots still, but birds were kept in cages to allow interaction
with animals, and some even found their stay at the hospital as not too unpleasant.
Padded cells were still employed along with padded clothing but were used as sparingly
as possible.
Sedatives such as paraldehyde and hyoscine were introduced in the 1880s and warm water
bathing was a common treatment up to 8 and 9 hours per day in some cases.
But in the UK towards the end of the 19th century asylums were starting to over flow.
The hospital moved towards aiming to treat inpatients for only around a year, with other
arrangements needed if longer term treatment was needed.
There was a small incurable wing provided which would house some patents for the long
haul.
There was an entertainment hall opened in 1892, and the galleries resembled more of
a holiday retreat hotel, in addition there were outside activities such as bowls.
But a story as old as bethlem would start to develop towards the early part of the 20th
century.
Yes it was time to move again.
Oh yes the st georges fields site is actually the same building that the imperial war museum
lives in.
The 3rd move, to a sunny southeastern corner of London.
Well we are now back here, on the boundary between Croydon and Bromley, and the hospital's
current location.
This would bring Bethlem to the countryside, well at the time it was in 1930, and would
encompass a more modern villa style building system, with multiple separate wards, each
having their own kitchen.
The new site would welcome in a more modern approach to treatment, although the hospital
would see Electro convulsive therapy and insulin shock therapy.
In 1948 the hospital would be incorporated into the NHS, and would follow the more talking
therapy and medicinal approach more familiar today.
The hospital has still been a source of some controversy In recent years there have been
a couple of fatalities during restraint.
Now the current hospital covers a lot of ground, which is good for taking long walks, and incorporates
a secure wing, as well as the National Psychosis Unit.
Now if you are ever in this part of the world I highly recommend going to the museum of
the mind in the hospital, it is a fascinating place to visit.
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