Bethlem Royal Hospital  

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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.
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Train wreck at Montparnasse (October 22, 1895) by Studio Lévy and Sons.

The Bethlem Royal Hospital of London is a psychiatric hospital at Beckenham in the London Borough of Bromley. Although no longer in its original location and buildings, it is recognised as the world's first and oldest institution to specialise in the mentally ill. It has been variously known as St. Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam.

The word bedlam, meaning uproar and confusion, is derived from its name. Although the hospital is now at the forefront of humane psychiatric treatment, for much of its history it was notorious for cruelty and inhumane treatment – the epitome of what the term "madhouse" connotes to the modern reader.

History

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, from where the building took its name. Its first site was in Bishopsgate (where Liverpool Street station now stands). In 1337 it became a hospital, and it admitted some mentally ill patients from 1357, but did not become a dedicated psychiatric hospital until later. 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, and 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.

Many sources assert that, in 1620, patients of Bethlem banded together and sent a "Petition of the Poor Distracted People in the House of Bedlam (concerned with conditions for inmates)" to the House of Lords. However, the absence of a primary document suggests that this may well be a 'phantom reference'.

The Hospital became famous and notorious for the brutal ill-treatment meted out to the mentally ill. In 1675 Bedlam moved to new buildings in Moorfields designed by Robert Hooke, outside the City boundary. The playwright Nathaniel Lee was incarcerated there for five years, reporting that: "They called me mad, and I called them mad, and damn them, they outvoted me."

The inmates were first called "patients" in 1700, and "curable" and "incurable" wards were opened in 1725-34. In the 18th century people used to go to Bedlam to stare at the lunatics. For a penny one could peer into their cells, view the freaks of the "show of Bethlehem" and laugh at their antics. Entry was free on the first Tuesday of the month. In 1814 alone, there were 96,000 such visits.

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" being used as a common diagnosis.

In 1815, Bedlam was moved to St George's Fields, Southwark, into buildings designed by James Lewis (a cupola was added later by Sydney Smirke). The inmates were referred to as "unfortunates" and must have had an uncomfortable time in their first winter there; no glass was initially provided for the windows, because of "the disagreable effluvias peculiar to all madhouses". In June 1816 Thomas Monro, Principal Physician resigned as a result of scandal when he was accused of ‘wanting in humanity’ towards his patients.

The new building had a remarkable library as an annex 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. The old hospital and its grounds were bought by Lord Rothermere and presented to the London County Council for use as a park; the central part of the building was retained and became home to the Imperial War Museum in 1936.

In the early modern period it was widely believed that patients discharged from Bethlem Hospital were licensed to beg, though in 1675 the Governors denied this. 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.

In 1997 the Bethlem hospital started planning celebrations of its history on the occasion of its 750th anniversary. The service user perspective was not to be included, however, and members of the Psychiatric survivors movement saw nothing to celebrate in either the original Bedlam or in current mental health care. A campaign called "Reclaim Bedlam" was launched by Pete Shaugnessey, which was supported by hundreds of patients and ex-patients and widely reported in the media. A sit-in was held outside the earlier Bedlam site at the Imperial War Museum. The historian Roy Porter called the Bethlem Hospital "a symbol for man's inhumanity to man, for callousness and cruelty."

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 meet the needs of people from across England and Wales and even Gibraltar, to judge its location by its ability to serve a local population conveniently may not be entirely appropriate).

21st century

In 1999, Bethlem Royal Hospital became part of the South London and Maudsley NHS Foundation Trust ("SLaM"), along with the Maudsley Hospital in Camberwell.

In 2001 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 started.

The new 89-bed, £33.5m unit (River House) opened in February 2008. It is the most significant development on the site since the hospital was formally opened at Monks Orchard in 1930. River House represents a major improvement in the quality of local NHS care for people with mental health problems. The unit provides care for people who were previously being treated in hospitals as far as 200 miles away from their families because of the historic shortage of medium secure beds in South-east London. This, in turn, was intended to help the NHS to manage people's progress through care and treatment more effectively.

The Hospital Trust still owns land throughout England, often left to it as a bequest. It owns a lease in Piccadilly for which it has paid the same peppercorn rent for over 200 years. This property is let out to shops and a hotel, which contributes to funding.





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