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.
Another example of restraints used \is the restraint chair shown below from 1869. This photo is from a different asylum in Britain.
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 hey 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.
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.
The present day
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). The NHS website section devoted to the history of the hospital conveniently glosses over the messy bits.
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.
- BBC: How Bedlam Became “a Palace for Lunatics”
- The 13th Floor: The Disturbing History of Bedlam: The World’s Most Notorious Insane Asylum
- Wellcome Collection
- Wikipedia: Bethlem Royal Hospital
- Wikipedia: Lunatic asylum
- Wikipedia: Straitjacket
- Wikipedia: Ten Days in a Mad-House
- Wikipedia: Utica Psychiatric Center
There’s more on stigma on my stop stigma page.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other major retailers.