It’s Bedlam Here!!

*Post written by Mona Meyer, Archives and Special Collections Metadata Librarian.

Everyone knows what this means—that all is chaos.  But do you know where the word came from?

In 1247, monks began to care for the sick and indigent in London at a place called St. Mary of Bethlehem.  It was a small place, “centred around a courtyard with a chapel in the middle, it had approximately 12 ‘cells’ for patients, a kitchen, staff accommodation and an exercise yard.”  In 1346 the hospital was taken over by the city of London.  At some time the focus changed from caring for the physically sick to caring for those with mental illness.  “Its subsequent specialisation in ‘madness’ gave it a future, although we know that its patients also included people with learning disabilities, ‘falling sickness’ (epilepsy) and dementia.  By 1403, ‘lunatic’ patients formed the majority of the Bethlem’s clients – and so England’s first, and perhaps most infamous, mental institution was born.”

The mentally ill have long suffered from both ignorance and stigma. “In the ancient world cultures, a well-known belief was that mental illness was “the result of supernatural phenomena”; this included phenomena from “demonic possession” to “sorcery” and “the evil eye”. The most commonly believed cause, demonic possession, was treated by chipping a hole, or “trephine”, into the skull of the patient by which “the evil spirits would be released,” therefore healing the patient.”  Hippocrates developed theories about the medical original of mental illness, but the superstitious ideal still held sway with most people.  “Historically, those with mental illnesses had a “social stigma” attached to them. It was believed that “a mentally ill member implies a hereditary, disabling condition in the bloodline” threatening the family’s “identity as an honorable unit”. In countries, or cultures, that had strong ties to family honor, such as China, the ill were hidden by their families so that the community or society that they were a part of wouldn’t believe the illness was “a result of immoral behavior by the individual and/or their relatives”.  As a result of this social stigma, many of the mentally ill were forced to either “live a life of confinement” or were abandoned and forced to live on the streets. Any of those that were abandoned to live on the streets and were rumored “dangerous and unmanageable” were either put in jail or dungeons, out of the public eye (Foerschner, 1).

Often, patients at St. Mary of Bethlehem were poor and/or abandoned by family members.  This, in addition to ignorance and superstition, led to horrific treatment.  One common practice was rotational therapy (developed by Erasmus Darwin, grandfather to Charles), whereby the patient sat in a chair suspended from the ceiling, which was then spun violently, as many as 100 revolutions/minute.  The subsequent nausea, vomiting, and incontinence were considered as signs of progress in the patient’s treatment.  “Bedlam was run by physicians in the Monro family for over 100 years, during the 18th and 19th centuries. During this time, patients were dunked in cold baths, starved, and beaten. William Black’s 1811 “Dissertation on Insanity” described the asylum thusly: “In Bedlam the strait waistcoat when necessary, and occasional purgatives are the principal remdies. Nature, time, regimen, confinement, and seclusion from relations are the principal auxiliaries.” He went on to describe the use of venesection (an archaic term for bloodletting), leeches, cupping glasses, and the administration of blisters.   Bedlam was so horrific that it would routinely refuse admission to patients deemed too frail to handle the course of their therapies.”

This is James Norris, “who was clad in a harness with chains running into the wall and into an adjoining room. When the staff saw fit, they would yank on the chains, slamming the unfortunate Norris into the wall.”  This treatment went on for years.

Remember that the hospital’s name was Bethlehem, which was corrupted in pronunciation as Bethlem.  It’s not much of a stretch from “Bethlem” to “Bedlam.”  It’s easy to see how the word “bedlam” came to mean chaos, uproar, disorder, pandemonium, and confusion.

When it was rebuilt in 1676, Bethlem looked more like Versailles than a mental hospital (Credit: Wellcome Library, London)

When it was rebuilt in 1676, Bethlem looked more like Versailles than a mental hospital (Credit: Wellcome Library, London).

“Designed by Robert Hooke, a City Surveyor, natural philosopher and assistant to Christopher Wren, its 540ft-long (165m) façade – complete with Corinthian columns and cupola-topped turret – was inspired by Louis XIV’s Tuileries Palace in Paris. It looked over formal gardens with tree-lined promenades. The overall impression was of the French king’s opulent estate at Versailles, not of an asylum.” The beautiful new palatial building was downright sinister, putting a beautiful face on the horrors occurring within.  At about this time, the ultimate indignity and humiliation for the unfortunate inmates began–Bedlam became a tourist attraction. For a fee, the wealthy were invited to tour the “zoo” and marvel at the spectacle.

Bedlam may have been the most infamous of mental hospitals, but it was certainly not the only one, and care at the others was likely no better. Fortunately, there were individuals whose study of mental illness and proposed therapies were more progressive. University Archives Special Collections has a small collection (MSS 085) of brief portfolios, created by Swiss pharmaceutical company Roche Laboratories, of information about medical practitioners who advocated for better treatment modalities.  These portfolios (at least some if not all) were sent to a local physician, Dr. Lillian G. Moulton, in 1965. Lilliam Gertrude Moulton Manual (1898-1992) worked for the Indiana Division of Mental Health from 1938 until 1949 and established a traveling child guidance clinic for those without easy access to this service. She had a private practice in Indianapolis, worked with Riley Hospital for Children, and taught at the Indiana University School of Medicine. From 1956-1975 she was director of the Vanderburgh County Child Guidance Center. (Findagrave.com)

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One portfolio provides information on Johann Weyer (1515-1588), called the Father of Medicolegal Psychiatry. Weyer was a Dutch physician, educated at the University of Paris.  He lived in a time when the fear of witchcraft was rife, and witch hunts, trials, and burning at the stake were prevalent. In 1563, he wrote a pioneering work entitled De praestigiis daemonum, et incantationibus ac veneficiis, which translates to On the Illusions of the Demons and on Spells and Poisons, in which he postulated that those accused of witchcraft were mentally ill.

Another portfolio tells the story of Thomas Story Kirkbride (1809-1883), an American who earned a medical degree from the University of Pennsylvania in 1832.  Shortly after he began his own practice, he was offered and accepted the position of superintendent at the Pennsylvania Hospital for the Insane. “His ambition, intellect, and strong sense of purpose enabled him to use that position to become one of the most prominent authorities on mental health care in the latter half of the nineteenth century. Kirkbride was a founding member of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII) —forerunner of the American Psychiatric Association—serving first as secretary, then later as president from 1862 to 1870. Kirkbride pioneered what would be known as the Kirkbride Plan, to improve medical care for the insane, as a standardization for buildings that housed the patients.”  Kirkbride’s Plan advocated for humane treatment in a comfortable, well-ventilated, well-lit, facility, with not more than 250 patients. The hospital—he preferred that term to insane asylum—should be built in the country, with lots of garden/outdoor space. No attendant should be responsible for more than 10 patients.  In the section of his plan entitled “Propositions Relative to the Organization of Hospitals for the Insane,” Article XIV states, “All persons employed in the care of the insane should be active, vigilant, cheerful, and in good health.  They should be of a kind and benevolent disposition; be educated, and in all respects trustworthy; and their compensation should be sufficiently liberal to secure the services of individuals of this description.” (MSS 018-1-2)

Adolf Meyer (1866-1950). Source: Roche Laboratories, MSS 085-1-5.

Adolf Meyer (1866-1950). Source: Roche Laboratories, MSS 085-1-5.

Adolf Meyer (1866-1950) is called the “Dean of American Psychiatry. Earning his medical degree from the University of Zurich in 1892, this Swiss-born American was a neuropathologist for the Illinois Eastern Hospital for the Insane from 1893-1895 and advocated for taking accurate case histories of patients; he began to believe that “the disorder in mental illness results essentially from personality dysfunction rather than brain pathology. He was chief pathologist of the mental institution at Worcester, Massachusetts (1895–1902), and then became director of pathology for the Pathological Institute of the New York State Hospital Service, Ward’s Island (1902–10), and professor of psychiatry at the Cornell University Medical College, New York City (1904–09). As he became more aware of the importance of social environment in the development of mental disorders, his wife (née Mary Potter Brooks) began visiting patients’ families. Her interviews are considered the first effort in psychiatric social work.  In 1910 Meyer became professor of psychiatry at Johns Hopkins University (Baltimore) and later director of its Henry Phipps Psychiatric Clinic (1914). Until he retired in 1941, he impressed generations of students with the idea that, in the diagnosis and treatment of mental illness, account must be taken of the patient as a whole person.”

Daniel McNaughton (1813-1865). Source: Unknown.

Daniel McNaughton (1813-1865). Source: Unknown.

Daniel McNaughton (1813-1865) was a Scottish man who influenced the field not through his accomplishments, but rather through his mental illness. Under the delusion that there was a conspiracy against him, he decided to kill Prime Minister Sir Robert Peel.  On January 20, 1843, he spotted Edmund Drummond, Peel’s private secretary, coming out of Peel’s residence and mistook him for the prime minister. He followed Drummond and shot him in the back; Drummond died several days later. There were many witnesses, and his trial and subsequent acquittal on the grounds of insanity was Victorian England’s equivalent of our “media circus.”  Public outrage forced the House of Lords to investigate and publish the first set of rules for determining criminal insanity.

“The following are the main points of [what became known as] McNaughton’s rules:

Every man is to be presumed to be sane and to possess a sufficient degree of reason to be responsible for his crimes, until the contrary be proved.

An insane person is punishable “if he knows” at the time of crime.

To establish a defense on insanity, the accused, by defect of reason or disease of mind, is not in a position to know the nature and consequences.

The insane person must be considered in the same situation as to responsibility as if the facts with respect to which the delusion exists were real.

It was the jury’s role to decide whether the defendant was insane.”

From being furiously twirled about, to chains and straitjackets, to the asylum as a tourist attraction, to Kirkbride’s humane treatment and conditions, to today’s medical practice of psychiatry—while the mentally ill are not always treated appropriately even today, we’ve come a long way from Bedlam!

Resources Consulted:

Asokan, T.V.  “Daniel McNaughton (1813-1865).” Indian Journal of Psychiatry: v. 49, no. 3 (July-September 2007),p. 223-224.

A Beautiful Mind: The History of the Treatment of Mental Illness.  (History Cooperative)

Casale, Steven. “Bedlam: The Horrors of London’s Most Notorious Insane Asylum.”  Huffpost, March 18, 2016/updated December 6, 2017.

Encyclopedia Brittanica online.  “Adolf Meyer.”  September 9, 2018.

From Bethlehem to Bedlam – England’s First Mental Institution.

Malcolm, Lynne and Clare Blumer.  “Madness and insanity: A history of mental illness from evil spirits to modern medicine.”  Australian Broadcasting Corporation News online, August 2, 2016.

Ruggeri, Amanda.  “How Bedlam Became ‘a Palace for Lunatics.’”  BBC culture, December 15, 2016.

Virginia Commonwealth University Social Welfare History Project.  “Thomas Story Kirkbride 1809-1883 — Physician, Psychiatrist and Developer of the Kirkbride Plan.”

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