Bethlem Hospital

On 17 January 1852, Charles Dickens published in Household Words an article, ‘A Curious Dance Round a Curious Tree’, his account of a dance he attended at St Luke’s Hospital for the Insane in London. He describes some of the dancers :

‘There was the brisk, vain, pippin-faced little old lady, in a fantastic cap – proud of her foot and ankle; there was the old-young woman, with the dishevelled long light hair, spare figure, and weird gentility; there was the vacantly-laughing girl, requiring now and then a warning finger to admonish her; there was the quiet young woman, almost well, and soon going out. For partners, there were the sturdy bull-necked thick-set little fellow who had tried to get away last week; the wry-faced tailor, formerly suicidal, but much improved; [...] There was the man of happy silliness, pleased with everything. But the only chain that made any clatter was Ladies’ Chain [...]‘1

The allusion to the chain is not accidental: this episode of organised sociability at Bethlem’s foremost rival asylum is in marked contrast to Dickens’ firm opinion that Bethlem itself was, and always had been, a disaster in the treatment of the insane, relying as it traditionally had on rigid discipline and punitive measures. The sociability at St Luke’s might have been forced, a pale fake of what was to be found in society beyond its walls, but it was an attempt at activity, promoting some kind of social cohesion within the asylum, at mixing, as it did, patients and staff, and some of the inmates, as Dickens makes clear, enjoyed it and gained benefit from it.

• 1. Charles Dickens, Household Words, 17 January 1852, p. 89-90. Cited in Simon Cross, Mediating Madness: Mental Distress and Cultural Representation (Basingstoke: Palgrave Macmillan, 2010), p. 74.

Few inmates of Bethlem, it seems, gained benefit from their stay during the course of the long eighteenth century, a period that closed with a damning report on the institution by a Parliamentary Committee in 1815, which resulted in its physician, Thomas Monro, and apothecary, John Haslam, both losing their jobs. The Committee heard of patients, nearly or completely naked, chained to the walls; of one man, James Norris, who had been confined in a restraining contraption for fourteen years; of regular immersion in cold water during the summer months irrespective of condition and of another inmate, named Fowler, who died shortly after such an immersion.2 These were hardly circumstances conducive to sociability. Patients with cells could be confined to them for trivial punitive reasons, or sent to the basement where the incontinent inmates were kept. Social intercourse in the galleries was, according to Urbane Metcalf, who published The Interior of Bethlem Hospital in 1818 after being confined there, limited to one’s own floor, except in the ‘green yard’.3

• 2. See First Report. Minutes Of Evidence Taken before The Select Committee appointed to consider of Provision for the better Regulation of Madhouses, in England (London: House of Commons, 1815), p. 11-12, 102-104.
• 3. Urbane Metcalf, The Interior of Bethlem Hospital (1818), in Dale Peterson (ed.), A Mad People’s History of Madness (Pittsburgh: University of Pittsburgh Press, 1982), p. 78.

Nevertheless, Bethlem had traditionally, and throughout most of the eighteenth century, afforded one kind of sociability, though not for the benefit of the inmates. This was the practice of allowing the admission of paying spectators. Until 1770 it was open to visitors on six days of the week for a nominal contribution (After 1770 a ticket system was introduced).4  Here individuals and groups could wander and enjoy the antics of the inmates, goaded often by the warders in the hope of gratuities, and could tease or reward the most amusing. This was a species of sociability that confirmed the sanity of the sane, providing thereby a spurious group cohesion along with a pleasant day out. Indeed, as Ned Ward described in his satirical periodical The London Spy in 1699, the sociable nature of a visit to Bethlem could include not only cheap entertainment but satisfaction of a more earthy kind:

‘Having pretty well tired ourselves with the frantic humours and rambling ejaculations of the mad folks, we took a turn to make some few remarks upon the looseness of the spectators, amongst whom we observed abundance of intriguing.

Mistresses, we found, were to be had of all ranks, qualities, colours, prices and sizes, from the velvet scarf to the Scotch plaid petticoat. Commodities of all sorts went off, for there wanted not a suitable Jack to every Jill.‘5

A cross-section of English society, in fact, could be observed visiting Bethlem, brought together by the lowest common denominators of needs: to laugh at others, to satisfy sexual desire, and, in the case of the ‘Mistresses’, simply to survive. Sociability serves many functions, and one person’s chance for company while enjoying a virtually public entertainment is another’s opportunity for earning a few pence.

• 4. See Roy Porter, Mind-Forg’d Manacles: A History of Madness in England from the Restoration to the Regency (London: Athlone Press, 1987), p. 122.
• 5. Ned Ward, The London Spy, ed. Paul Hyland (East Lansing: Colleagues Press, 1993), p. 57. (Hyland’s text is that of the fourth collected edition of 1709.).

As Roy Porter observes, though, ‘Bethlem the institution was small; ‘Bedlam‘ the image loomed large in the public imagination’ (p. 122). Bethlem was not only a sociable place to visit, it also had been known, since at least the Renaissance, as Bedlam, standing for society’s fears – fears of chaos, of unreason unchained, and of the fragility of human sanity. This was something played upon and contributed to by satirists such as Alexander Pope and William Hogarth, certainly, but also, if Ward is reporting anything based on fact, by inmates themselves. The Spy and his companion, along with other visitors, begin to question the mad men and women:

'Prithee,’ says my companion, ‘what was the occasion of thy distemper?’ To which he answered, ‘I am under this confinement for the noble sins of drinking and whoring, and if thou hast not a care it will bring thee into the same condition.’

Another was holding forth with as much vehemence against Kingly government as a brother of Commonwealth doctrine. [...] I told him he deserved to be hanged for talking of treason. ‘Now,’ says he, ‘you’re a fool, for we madmen have as much privilege of speaking our minds, within these walls, as an ignorant dictator. [...] Prithee come and live here, and you may talk what you will, and nobody will call you in question for it. Truth is persecuted everywhere abroad, and flies hither for sanctuary.‘[...]

Another was talking very merrily at her peeping-hole to a crowd of auditors, most of them young wenches. [...] In this interim came by a beauish blade with his wig very much powdered. ‘Look, look!‘ cries Bess of Bedlam. ‘Yonder goes a prodigal puppy, an extravagant rascal that has got more flour in his wig than my poor mother has in her meal tub to make a pudding withal!‘‘ (Ward 56-57)

Those who come to Bethlem seeking an exploitative form of sociability find reflected back to them the Bedlam of their own society, distorted, filtered through the perspective of madness, or so-called madness, but bearing undeniable truths about life on the outside: its self-interest, its restrictiveness, its ludicrous enslavement to fashion, its outrageous inequality in terms of wealth and privilege, in fact its genuine lack of anything other than a form of sociability as fake as that which Dickens was to witness at St Luke’s in the following century. If sociability has anything to do with fellow feeling and the benefits of sharing a social space, then society beyond the madhouse would seem to have even less claim to that than the community of individually insane men and women confined within it.

John Haslam, the Bethlem apothecary who was dismissed from his post over a century after Ward was writing, wrote of how long confinement can affect an inmate, particularly as far as memory is concerned:

‘It shews how treacherous the memory is without reinforcement. The same necessity of constant recruit and frequent review of our ideas, satisfactorily explains, why a number of patients lapse nearly into a state of ideotism. These have, for some years, been the silent and gloomy inhabitants of the Hospital, who have avoided conversation, and sought solitude; consequently have acquired no new ideas, and time has effaced the impression of those formerly stamped upon the mind.‘6

In other words, though Haslam does not spell it out, long confinement goes against everything that makes for sanity. Indeed, Haslam, in a moment of insight, is describing what might be called ‘anti-sociability’, each mad individual locked within the cell of his or her own convictions, forgetful of social pleasures and interactions, regarding other inmates as mere bystanders, or intruders, or even as mad. This is Bethlem. But as Bedlam, the same situation was utilised by writers and artists, and within the wider public imagination, as a mirror, albeit a strange and distorted one, on what passed for a normal state of sociability.

• 6. John Haslam, Observations on Insanity (London: F. And C. Rivington, 1798), p. 21-22.