From inhuman care, bedlam

Bethlem Royal Hospital in London is one of the oldest psychiatric hospitals in the world -- and perhaps the only one to have endured centuries of notoriety for fetters, flogging, filth and exploitation. (In the 1700s, Londoners could pay an admission fee to see and torment the patients.) Today Bethlem, vastly improved, is part of Britain’s National Health Service -- and, popularly called Bedlam, is also part of the English language. The name Bedlam has entered our vocabulary as a word for chaos, confusion and disorder. But the hospital was likely so immortalized not because it was worse than any other asylum in history but because for centuries, it was the only one.

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Bethlem was founded in 1247 as a Roman Catholic priory, or religious house, with no recorded intention of becoming an asylum for the mentally ill. But a century later (historians still aren’t sure why) the priory began taking in “Lunaticks,” as they’re called in records from the time.

By 1403, Bethlem housed six men, four pairs of shackles, two stocks and nearly a dozen chains. And as the numbers of prisoners (as patients were often then called) grew, their living conditions worsened. Prison-like conditions for the insane were not unusual in medieval Europe, but Bethlem combined them with violence, neglect and corruption.

The final rub came when patients were discharged -- with little but an official license to beg on the streets of London. (Shakespeare’s “King Lear” features such a ubiquitous Bedlam beggar, though historians are now fairly certain more beggars claimed to be former Bedlamites than ever spent time in the hospital.)

Worse practices were still to come, when the hospital’s doors were opened to the public -- as a form of entertainment. For a penny apiece (or gratis on the first Tuesday of the month, a harbinger of museum tradition to come), visitors could view the Lunaticks and even poke them with sticks to incite fights and displays of rage.

In 1814, a visitor to the hospital wrote of a patient named James Norris, who was pinned to a wall by iron bands fastened around his neck, abdomen and arms -- a position he had been held in for 12 years. In other rooms, patients were chained to walls by a single arm or leg, up to 10 per room, dressed in shoddy nightgowns even in the cold of winter.

A government committee charged with investigating the hospital concluded that such treatment was “merciful” and “humane” -- though it also found the hospital’s current director nearly absent, its surgeon an alcoholic and its druggist an on-the-job drinker. Finally, in 1852, Dr. Charles Hood took over. He urged staff to keep patients neat and clean and replaced the hospital’s dusty floors and cold walls with a robust library, birds and artwork, carpeting and fireplaces, grassy lawns and flowers, parties and needlework -- and not a shackle in sight.

But by that time, asylums throughout Europe had long since traded in chains for treatment. Bethlem was merely catching up.

-- Elena Conis