Bedlam revisited: A history of Bethlem hospital 1634-1770.

Abstract

This thesis takes issue with a polemical historiography of Bethlem which has tended to 'view the hospital as a nadir in the history of psychiatry, and to accept, too uncritically, the distorted metaphor of 'Bedlam' for the reality. It argues that there was not the radical equivalency that some historians have posited between animalistic conceptions of the insane and the actual practices and policies pursued at early modern Bethiem. Nor was this paradigm of madness the only oae prevailing in the classical period, Bethlem patients also being regarded (e.g.) as 'objects of charity', requiring both mental and bodily relief. Rather than 'brutalized', it is sustained, the inmates of Bethiem were being managed and maintained, although inadequately and inefficiently. What modern commentators have disparaged as maltreatment and squalor at Bethlem, was not merely the result of an attitude to the mad as brutes, but was also the result of a lack of resources and a failure to measure up to the ideals of provision. Furthermore, it is demonstrated that the squalor and brutality of Bethiem was neither as extreme, nor as undifferentiated, as has been alleged. The hospital is located comprehensively within the context of contemporary provision for the sick and insane poor, Bethiem having too often been portrayed as if a separate island of sequestered madness. Rather than describing an immutable monolith of tradition and apathy, significant areas of evolution and innovation in the care and treatment of the insane at the hospital are delineated. Uniquely exposed to public scrutiny, the environment of Bethiem was subject, more than that of any other contemporary hospital, to powerful external forces of arbitratioia. A particular focus of the analysis entails the complex interactions between the hospital's administrators and inhabitants, and the public at large. Inter-relations between Bethlem's visitors, staff and patients, and between the insane and those who supported and committed them, have especially suffered from simplistic interpretations, and from a general ignorance with the hospital's own records and with the records of other administrative and juridical bodies dealing with the poor insane. A major preoccupation of this survey has been to contribute greater nuance and balance to standard readings of responses to the insane, both within and without the hospital.