Early Insane Asylums: Bedlam and Beyond

engraving of Bedlam asylum
Public domain

This post is a follow-up of sorts to a guest post I did recently on Renard’s World. While that post focused on the dark side of psychiatry in the 1900s, in this post we’ll look even further back in history at some of the frightening goings-on in early asylums to “treat” people with psychiatric illnesses.

Bethlem Hospital

The very first “lunatic asylum” was Bethlem Hospital, which also came to be known by its nickname Bedlam. It was founded in the 13th century in an area that at the time was just outside of London. It started off as a church priory with the purpose of collecting alms and housing the poor.  Over time the purpose evolved, and it’s speculated that by 1377 it had become an insane asylum.& It’s clearly documented that, by 1403, this was its purpose.

Sanitation was poor and the patients were malnourished. Most of the patients were able to move about freely, but those who were considered dangerous were kept chained to the walls. Patients’ families often dumped unwell family members in the asylum and disowned them, and archaeologists have found mass graves dating back to the 1600s.

In 1676, Bedlam moved into a new building in Moorfields that was constructed in the style of the Tuileries Palace in Paris. Despite the fancy exterior, it was built on poor foundations and the facade was so heavy that it created cracks where water would run into the building every time it rained.

“Treatments” included leeches, blood-letting, ice baths, starvation, and beatings. In the 1700s, Charles Darwin’s grandfather, Erasmus Darwin, began using “rotational therapy”, which involved spinning a patient around and around on a chair or swing for up to an hour. The vomiting that this induced was seen as a good thing.

The early 1800s were a particularly grim time, and many patients were chained to the walls naked or almost naked, as the medical director felt that it was necessary to break each person’s will.

From approximately the early 1600s until 1770, the public was able to go for a wander through Bedlam. Money was collected as entrance fees, and it was hoped that seeing the crazy people would make people feel sufficiently compassionate that they would donate funds to the hospital.

The Wellcome Collection has some fascinating depictions of life at Bedlam. The two drawings below are from the early 1800s and represent the same patient, an American whose name was apparently James although the drawings indicate the name William. There is a contraption around his arms and chest by which he is chained to the wall, as well as shackles around his ankles. He remained this way for ten years or more.

prisoner shackled to his bed in Bedlam Asylum
William Norris, shackled on his bed at Bedlam. Credit: Wellcome CollectionCC BY
patient chained and shackled to his bed at Bedlam asylum
William Norris restrained by chains at the neck and ankles in Bethlem hospital, London. Coloured etching by G. Arnald, 1815, after himself, 1814. Credit: Wellcome CollectionCC BY

Another example of restraints used is the restraint chair shown below from 1869. The photo below is from a different asylum in Britain.

man in restraint chair in an asylum
Man in restraint chair at the West Riding Lunatic Asylum, UK – H. Clarke, 1869– Wellcome Trust

Asylums in the United States

A supposedly more humane alternative to ropes and chains was developed in the 1700s – the straitjacket. In the United States in the 1800s, the mentally ill began to be shifted from poorhouses and prisons to asylums, with the number of asylums growing from 9 to 62 between the years 1825 and 1865. Since doctors at the time had only nonsense explanations for the causes of mental illness (e.g. reading novels), treatment was non-existent and the use of straitjackets was common practice.

In the mid-1800s, the director of the New York State Lunatic Asylum at Utica decided that using chains to restrain patients was a bad idea, so instead they came up with the so-called Utica crib. It’s shown below, and yes, that’s a mattress and a patient crammed in there. How civilized.

drawing of an utica crib, a bed covered with railings
Minnesota Council on Developmental Disabilities

In 1887, journalist Nellie Bly convincingly feigned insanity and spent ten days in the Women’s Lunatic Asylum on Blackwell Island in New York.  The food and water were of awful quality. Nurses would beat the patients, and Bly was beaten with a broom handle. Patients were bathed by dumping cold water over their heads, with the same water and towels being used for multiple patients. The place was filthy and infested with rats.  The inmates were forced to spend the day in silence sitting on hard benches, and dangerous patients were tied together using ropes.

Beyond Bedlam?

From that little stroll through history, we return to the present day. Bethlem Royal Hospital still exists, after having moved sites in 1815 and again in 1930. It’s now part of the U.K.’s National Health Service (NHS). It strikes me as a poor choice to retain the association with such a horrific legacy. Choosing to maintain that continuity rather than going for a major rebrand doesn’t send an encouraging message.

We’ve come a long way, but maybe not as far as we should.


The post Cell Phones on Psych Wards—Yea or Nay? is the hub for all psychiatric hospitalization-related content on Mental Health @ Home.

28 thoughts on “Early Insane Asylums: Bedlam and Beyond”

  1. Yes, I agree with this place, with the terrible history of it all, you think the name would have gone. Hearing the name of the place just makes me cring and associate the bad things with it and not however it is now.
    I say ‘however it is’ with not being anywhere near this place, with not living that way, to know what this place is like now.

  2. I love time travelling. But I don’t know if we evolved that much. For some patients yes but others are still being restrained because we simply do not know better or we can’t do better. I’ve heard stories. Maybe not that horrific as from more than 100 years ago. But in the ’60 the ice baths were in place. I remember a doctor telling that in earlier days difficult patients were injected with lactic acid because that made the mind occupied with other things. Can you imagine?
    My patients (my workplace used to be an women psy hospital run by nuns) told me about the good ol’ day; they worked and worked day in, day out. There was a laundry and a bakery and a lot of prayers to do! Different times for sure.

      1. No they weren’t (just to be clear on my point of view!) but I was always so curious how it was for them, for the older ladies. They liked the staff from early days because they needed to pray and work with them. Staff also needed to restrain them, I mean, anti-psychotics came on the market from the ’50 or ’60 I believe (not sure about that!) but there were no good words for the nuns. The ladies were obliged to pray every day, multiple times a day under a specific tree. It was get up, work, pray, eat a little and sleep. When you were too ill too work, people were confined to their bed. Glad those days are over! Hopefully not to come again.

  3. I remember learning about nellie bly and her story in college. I did not know this place still exists today. Being chained and humiliated and crammed in a tight space sounds horrible. From what I know, most of the people sent their were healthy people. Their families just considered them unwell for stupid reasons.

  4. One of the earlier Bedlam buildings became the Imperial War Museum in London I think. I went there a few years ago. I shudder to think of the former “treatments” for the mentally ill – it’s just awful. And I completely agree that while we’ve come a long way with it, there’s still a lot of work to be done.

  5. I love this post Ashley. It brings back so many memories of studying mental health and the asylums in the Borough I lived in for 30 years. As you rightly said, ‘Bedlam’ moved to Moorfields in 1751 – round the corner from where I lived and in 1751 – St Luke’s Hospital for Lunatics was built on Old Street in Islington, London.

    I couldn’t believe when I heard from my favourite Consultant Psychiatrist, that the small estate that I lived on was built on the old St Luke’s site.

    So thank you.

    1. Johnzelle Anderson

      Currently listening to a podcast series about the Tuskegee Syphilis studies. Amazing how stuff had to get so inhumane before regulations came into play

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