Bethlem Royal Hospital

Bethlem Royal Hospital
South London and Maudsley NHS Foundation Trust (SLaM NHSFT)
Geography
Location	Bromley, London, England, United Kingdom
Organisation
Care system	Public NHS
Type	Specialist
Affiliated university	Institute of Psychiatry, King's College London
Services
Emergency department	No Accident & Emergency
Speciality	Psychiatric hospital
History
Opened	1247 as Priory 1330 as Hospital
Links
Website	http://www.slam.nhs.uk
Lists	Hospitals in England

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 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, 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.

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.

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 lunatics 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.

Scene of Bethlem Hospital from the William Hogarth's A Rake's Progress.

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.

Bethlem Hospital at St George's Fields, 1828

A view of Bethlem Hospital, published in 1896.

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". This 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 Consumer/Survivor/Ex-Patient 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."

Bethlem Royal today

Bethlem Royal Hospital is now part of the South London and Maudsley NHS Foundation Trust ("SLaM"), along with the Maudsley Hospital in Camberwell. SLaM is provider of the most extensive portfolio of mental health services in the United Kingdom, and a world leader in research, working in partnership with the Institute of Psychiatry, King’s College London.

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 (main stream mental health services in the latter three boroughs being provided by the Oxleas NHS Foundation Trust), along with national specialist services, e.g. 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.

Entrance to the Occupational therapy Department

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 displaying 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 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).

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 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, is intended to help the NHS to manage people's progress through care and treatment more effectively.

South London and Maudsley (SLaM) Charitable Funds are made up of donations that have been made to South London and Maudsley NHS Foundation Trust and its predecessor organisations. It is managed by the Trust's Board members, who invest in projects that support improved mental healthcare, wellbeing, infrastructure, innovative services, early-stage research projects, training and development.

The aim for the endowment is to be a key agent in enhancing mental health provision and changing how mental health is viewed - in the local community and on a wider scale. The charitable funds supports individuals and organisations (directly linked to the SLaM NHS Foundation Trust and external parties) to drive change, help ideas turn into reality and enable others to reach their true potential.

Academic Health Sciences Centre

SLaM is part of King's Health Partners Academic Health Sciences Centre (AHSC) - in partnership with King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust. King's Health Partners aims to promote health in mind and body (see www.kingshealthpartners.org). An AHSC is one of several terms which are used to describe an organisation which delivers both healthcare to patients and health-related science and research, usually with a well developed teaching and education role as well. This type of organisation is fairly common amongst the leading hospitals and universities around the world. There are currently five AHSCs in the U.K.

Biodmedical Research Centre

The Trust manages the U.K’s only Specialist Biomedical Research Centres in partnership with the Institute of Psychiatry, King’s College London. The Centre, which is based on the Maudsley Hospital campus, is funded by the National Institute for Health Research (NIHR). Its aim is to speed up the pace that latest medical research findings are turned into improved clinical care and services.

The team at the Centre are working towards 'personalised medicine' - developing treatments based on individual need. The aim is to diagnose illness more effectively and much earlier, assess which treatments will work best for an individual and then tailor the care they receive accordingly, so that they get better more quickly.

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 hospital's 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. The museum is a member of the London Museums of Health & Medicine.

The museum still owns land throughout England, often left to them as a donation. They own a lease in Piccadilly for which they have paid the same peppercorn rate for over 200 years. This property is let out to shops and a hotel, contributing to their funding.

Notable patients of Bethlem hospital

• Lemuel Francis Abbott, portrait painter
• Hannah Chaplin, mother of film actor Charlie Chaplin
• Moll Cutpurse, also known as Mary Frith or "The Roaring Girl", released from Bedlam in 1644 according to Bridewell records
• Richard Dadd, artist
• John Frith, would-be assailant of King George III
• James Hadfield, would-be assassin of King George III
• 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 shooting of Edward Drummond
• Jonathan Martin, the man who set fire to York Minster
• James Tilly Matthews, one time tea merchant and subject of the first book-length psychiatric case study
• Margaret Nicholson, would-be assassin of King George III
• Edward Oxford, tried for high treason after the attempted assassination of Queen Victoria and Prince Albert
• Martha Thompson, Methodist convert
• Louis Wain, artist
• Graham Arland Wainwright, Gothic painter

See also

• Abraham-men
• John Cutting (psychiatrist)
• The Monro family provided several generations of doctors who were principal physicians of the Hospital in the 18th and 19th centuries.
• Augustus Welby Northmore Pugin (1812–1852) English architect, best known for his work on the Houses of Parliament as well as many churches.

References

• Russell, David (1996). Scenes from Bedlam: History of the Bethlem Royal and Maudsley Hospitals. Baillière Tindall. ISBN 1873853394

External links

• Academic Health Sciences Centre
• "Archival material relating to Bethlem Royal Hospital". UK National Archives.
• National Institute for Health Research
• BBC text history
• Bethlem Royal Hospital Archives and Museum
• Catholic Encyclopedia: Bedlam
• Historical images of Bethlem In Monks Orchard Album
• Museum of London: Bedlam
• South London and Maudsley NHS Foundation Trust