Bethlem Royal Hospital

The Bethlem Royal Hospital of London, which has been variously known as St Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam, is the world's oldest psychiatric hospital. The word Bedlam has long been used for lunatic asylums in general, and later for a scene of uproar and confusion.

History of Bethlem
Bethlem has been a part of London since 1247, first as a priory for the sisters and brethren of the order of the Star of Bethlehem. Its first site was in Bishopsgate Street (where Liverpool Street station now stands). In 1330 it is mentioned as a hospital, and it admitted the mentally ill from 1377, though by 1403 there were only nine inmates. Early sixteenth century maps show Bedlam, next to Bishopsgate, as a courtyard with a few stone buildings, a church and a garden. Conditions were consistently dreadful, and the care amounted to little more than restraint. There were 31 patients and the noise was "so hideous, so great; that they are more able to drive a man that hath his wits rather out of them"'. Violent or dangerous patients were manacled and chained to the floor or wall. Some were allowed to leave, and licensed to beg. It was a Royal hospital, but controlled by the City of London after 1557, but managed by the Governors of Bridewell. Day to day management was in the hands of a Keeper, who received payment for each patient from their parish, livery company, or relatives. In 1598 an inspection showed neglect; the Great Vault (cesspit) badly needed emptying, and the kitchen drains needed replacing. There were 20 patients there, one of whom had been there over 25 years.

Bethlem Royal Hospital became famous and infamous for the brutal ill-treatment meted out to the insane. In 1675 Bedlam moved to new buildings in Moorfields, outside the City boundary. In the 18th century people used to go there to see the lunatics. For a penny one could peer into their cells, view the freaks of the &quot;show of Bethlehem&quot; and laugh at their antics, generally of a sexual nature or violent fights. Entry was free on the first Tuesday of the month. Visitors were permitted to bring long sticks with which to poke and enrage the inmates. In 1814, there were 96,000 such visits. The lunatics were first called &quot;patients&quot; in 1700, and &quot;curable&quot; and &quot;incurable&quot; wards were opened in 1725-34.

Eighteenth century Bethlem was most notably portrayed in a scene from William Hogarth's A Rake's Progress (1735), the story of a rich merchant's son whose immoral living causes him to end up in a ward at Bethlem. This reflects the view of the time that madness was a result of moral weakness, leading to 'moral insanity' to be used as a common diagnosis.

In 1815, Bedlam was moved to St George's Fields, Lambeth (into buildings - designed by Sydney Smirke - now used to house the Imperial War Museum), where the inmates were finally referred to as "unfortunates." This building had a remarkable library as an annexe which was well frequented. Although the sexes were separated, in the evenings, those capable of appreciating music could dance together in the great ballroom. In the chapel the sexes were separated by a curtain. Finally, in 1930, the hospital was moved to an outer suburb of London, on the site of Monks Orchard House between Eden Park, Beckenham and Shirley.

In the early modern period it was widely believed that patients discharged from Bethlem Hospital were licensed to beg. They were known as Abraham-men or "Tom O' Bedlam". They usually wore a tin plate on their arm as a badge and were also known as Bedlamers, Bedlamites, or Bedlam Beggars. In William Shakespeare's King Lear, the Earl of Gloucester's son Edgar takes the role of a Bedlam Beggar in order to remain in England unnoticed after banishment. Whether any were ever licensed is uncertain. There were probably far more who claimed falsely to have been inmates than were ever admitted to the hospital.

Bethlem Royal today
Bethlem Royal Hospital is now part of the South London & Maudsley NHS Trust ('SLaM'), along with the Maudsley Hospital in Camberwell. SLAM provides mental health and substance misuse services to people from Croydon, Lambeth, Southwark and Lewisham, together with substance misuse services for Bexley, Greenwich and Bromley, along with national specialist services, eg the National Psychosis Unit. There are a range of services at the Hospital, from substance misuse and eating disorders services to units for children and adolescents.

The hospital also houses an active occupational therapy department, well-known for its vibrant exterior and focus on the arts. The department has its own art gallery that displays the work of current patients, and a number of noted artists have been past patients at the hospital over the years. Several examples of their work can be found in the Bethlem museum.

Until the 1990s, the hospital and its grounds were in the London Borough of Croydon, but were swapped with the London Borough of Bromley for South Norwood Country Park. This has meant that the hospital is now located in a community which it does not primarily serve, (although as many of its services are meeting the needs of people from across England, Wales and even Gibralter, to judge its location by its ability to serve a local population conveniently may not be entirely appropriate).

This tension caused most difficulty when SLAM sought planning permission for an expanded Medium Secure Unit in 2001 and extensive further works to improve security, much of which would be on Metropolitan Open Land. Local residents groups organised mass meetings to oppose the application, with accusations that it was unfair most patients could be from inner London areas and therefore not locals and that drug use was rife in and around the Hospital. Bromley Council eventually refused the application, with Croydon Council also objecting. However the Office of the Deputy Prime Minister overturned the decision to refuse in 2003, and development is about to commence on the site.

Museum and archives
Since 1970, there has been a small museum at Bethlem Royal Hospital. It is open to the public on weekdays. The museum is mainly used to display items from the museums art collection, which specialises in work by artists who have suffered from mental health problems, such as former Bethlem patients Richard Dadd and Louis Wain. Other exhibits include a pair of statues by Caius Gabriel Cibber known as Raving and Melancholy Madness, from the gates of the 17th century Bethlem Hospital, 18th and 19th century furniture, and documents from the archives. Due to the size of the museum only a small fraction of the collections can be displayed at one time, and the exhibits are rotated periodically.

Bethlem Royal Hospital possesses extensive archives from Bethlem Hospital, the Maudsley Hospital and Warlingham Park Hospital, and some of the archives of Bridewell Hospital. There are documents dating back to the 16th century, as well as full modern patient records. The archives are open for inspection by appointment, subject to the laws of confidentiality governing recent patient records.

The Bethlem Royal Hospital Archives and Museum is governed by a registered charity called the Bethlem Art and History Collections Trust.

Notable patients of Bethlem hospital

 * Lemuel Francis Abbott, portrait painter
 * Hannah Chaplin, mother of film actor Charlie Chaplin.
 * Richard Dadd, artist.
 * James Hadfield, would-be assassin of King George III.
 * James Tilly Matthews one time tea merchant and subject of the first book-length psychiatric case study.
 * Daniel M'Naghten, catalyst for the creation of the M'Naghten Rules (criteria for the defence of insanity in the British legal system) after the attempted murder of the Prime Minister Robert Peel.
 * Louis Wain, artist.