Location, Location 3

At the start of the nineteenth century, Bethlem’s Governors began actively seeking new premises for the Hospital. By then, as previously noted on this thread, all the perceived advantages of the Moorfields building had been irredeemably compromised (along with the healthful purity of the Moorfields air). In requiring asylums to be built in “an Airy and Healthy Situation, with a good supply of Water”,¹ the 1808 County Asylums Act followed contemporary medical opinion in placing a high premium on the siting of residential psychiatric facilities. The Governors’ relocation plans were not constrained by the Act, Bethlem being a private hospital, but they were infused by the Zeitgeist. Their first preference was for seven acres of high ground in Islington; but it proved impossible to interest the vendors in the transaction, which (since the Governors were tenants on a 999-lease on the Moorfields site) would involve the direct exchange of land, rather than of cash. They eventually settled upon a site south of the river in Southwark, a suburb which laboured under the disadvantage of being “swampy, overcrowded and predominantly poor”, but had the fact of its being City-owned and available to recommend it.²

In August 1815, Bethlem’s 122 patients were brought from the old hospital to the new in a succession of hired Hackney cabs. In their first winter, they must have been exposed to rather too much air, since the building’s “system of warming by steam was installed only in the basement storey and the windows in the upper storeys were either exposed to the full blast of cold air or were completely darkened” by being shuttered.³ Moreover, this was, in all likelihood, air of the wrong sort, Southwark at that time sharing with Lambeth the highest number of smoke-consuming furnaces in London.⁴ Though at first a somewhat mealy-mouthed defence of this system of open ventilation (“for obviating the disagreeable effluvias to which, as Dr Latham has observed, is peculiar to all Madhouses”⁵) was offered, the windows were glazed, and amendments made to the heating system, in 1816.⁶

The Hospital’s maintenance of a convalescent department in rural Surrey (within the grounds of King Edward’s School Witley, which shared its governance with Bethlem, and had been recently moved there from central London) between 1870 and 1929 is evidence that its immediate environs in Southwark were not proving to be sufficiently therapeutic. There is little doubt that “beautiful Witley” exercised a beneficial effect on the minds of a good many of Bethlem’s patients over these years. However, Bethlem’s Governors had no intention of turning their backs on London, having stubbornly resisted pressure brought to bear on them throughout the 1860s to relocate to the countryside.⁷ When another move finally did take place, some sixty years later, it was to a suburban site no more than ten miles from Charing Cross. As is well known, the old hospital was then given over to the use of the Imperial War Museum. “It is perhaps appropriate”, wrote a London County Council surveyor of the 1950s, “that a building occupied for so many years by men and women of unsound mind should now be used to house exhibits of that major insanity of our own time”.⁸

¹ Kathleen Jones, Asylums and After: A Revised History of the Mental Health Services from the early 18th century to the 1990s (London, 1993), p. 37.

² Jonathan Andrews et al, The History of Bethlem (London, 1997), p. 403.

³ Ida Darlington, The Survey of London: St George’s Fields, volume xxv (London, 1955), p. 78.

⁴ Jonathan Andrews et al, The History of Bethlem (London, 1997), p. 403.

⁵ Minutes of Evidence taken before the Committee on the State of the Madhouses, 1815-1816, p. 194.

⁶ Robert Howard, ‘A lesson from the history of psychiatry: competitive tendering for services and defective central heating systems in Georgian New Bethlem’, Psychiatric Bulletin (1991), pp. 566-568.

⁷ Jonathan Andrews et al, The History of Bethlem (London, 1997), pp. 498-502.

⁸ Ida Darlington, The Survey of London: St George’s Fields, volume xxv (London, 1955), p. 80.

The Politics of Interior Decoration

As mentioned in a recent post to our  In the Frame thread, Oliver Sacks devotes a chapter of his recent book Hallucinations to recounting the hallucinogenic experiences of himself, his patients and correspondents and those who have featured in medical literature on the subject since the 1840s. He could have included the visionary experiences to which Christopher Mayhew was subject after he took mescaline as part of a 1955 experiment for the BBC’s Panorama programme, footage of which was withheld from broadcast.

Mayhew was a British Labour MP with a sustained interest in issues of public health. (Later, in 1957, he checked himself into Warlingham Park Hospital in a bid to obtain first-hand experience of what a mental hospital was like, and also in order to interview staff and patients for the BBC.) During the experiment, which was conducted by Dr Humphrey Osmond, Mayhew pays unusually close attention to patterns he saw on a curtain hanging just out of shot, which he describes as having “the most extraordinary gradations of mauve, and ah, and ah, lights (sorry, it’s just my own poverty of vocabulary, I can’t describe it)”, and declares himself “amused” when Osmond ventures that “it look[s] to be a rather dull orange-red curtain”.

A variety of other causes of hallucinations are discussed in Oliver Sacks’ book. Among them is sensory deprivation (“the prisoner’s cinema”), which is commonly held to be the cause of the most celebrated fictional hallucinations in modern literature – those of the unnamed female protagonist in Charlotte Perkins Gilman’s short story The Yellow Wallpaper – an early example of the multiple forays writers of fiction have made into the arena of “madness” and mental health treatment over the last century and a half. Gilman’s spare prose does not actually assert, but encourages readers to infer, that the growing fascination with the wallpaper which is the central preoccupation of the book is the direct result of the application of a form of the ‘rest cure’ promulgated in the late nineteenth and early twentieth centuries by Dr Silas Weir Mitchell.

This managed regime of seclusion, bed rest and diet inter alia became a target of early feminists such as Gilman and (Virginia) Woolf, and it is easy to see why. They thought that the “rest cure” amounted to an assault upon the wills of (usually female) patients on the part of (usually male) doctors, in the context of unequal power relations between the sexes. No doubt they were right about the inequality of power between the sexes, but, as has been acknowledged within second wave feminism, it hardly seems fair to lay the blame for this entirely at the door of medical practitioners. “The nervous women of the fin de siècle were ravenous for a fuller life than their society offered them, famished for the freedom to act to make real choices,” writes Elaine Showalter. The doctors of that generation did nothing to dismantle patriarchy, true enough, but they did employ the “rest cure” to restore their patients, some of whom “had been total invalids of many years’ duration”, to “lives that were much more active and satisfying than the ones they had been leading”.¹

Of course, such was not the case for the fictional protagonist of The Yellow Wallpaper. Her visual hallucinations, of the patterns on the wallpaper forming bars behind which a woman was (or many women were) trapped, comprise an eloquent protest, not so much against Weir Mitchell, Gilman’s ostensible target, as against the historical and social constraints that framed Victorian womanhood.

1 Elaine Showalter, The Female Malady (Virago, 1985), pp. 140-144.

Life in a Victorian Asylum 3: Patient Rights

It’s easy to assume that, once inside in an asylum, Victorian patients had no rights whatsoever. Many were, however, well able to communicate with the outside world. Letters to the Commissioners in Lunacy or the Home Office – or, in the case of many private patients, their solicitors – were by law to be forwarded unopened. Other letters could be checked by the medical officers, but had to be shown subsequently to the Commissioners, to ensure that this had been done to protect the patient or prevent offence to others: a fine of £20 was payable if letters had been wrongly withheld. Although the decision to withhold letters does seem to have been made fairly often (given the numbers of letters addressed to outside parties pasted into patient records), there are also occasions when patients’ letters appear in the case books alongside a complaint from a relative who has returned them, urging the Hospital to be more strict in their censorship. There was, then, no hard and fast rule as to what was considered permissible.

In January 1895, a middle-aged gentleman by the name of Edward Peter King was admitted to Bethlem. King’s case well illustrates the lines of communication open to an asylum patient in the late nineteenth century. Diagnosed with mania, he was regarded as talkative and troublesome. He was constantly writing letters to the Home Office which, rather to his doctors’ annoyance, were often responded to, making him “more fixed in his idea about his importance & the interest taken in him by the State.” Several months after his admission, King ensured that he received a second medical opinion on his case after writing two letters to the eminent George Savage (a previous Bethlem superintendent) asking him to call, which he did, noting that “at all events I consider him insane as far as CONDUCT is concerned & if at large I believe he will always be getting into scrapes.”

King certainly managed to get into a number of “scrapes” even at Bethlem, apparently irritating his fellow patients by constantly passing wind audibly (on one occasion this so aggravated a Mr Rowland that he threw a book at King, and tried to follow this up with a vase before being stopped by an attendant). On March 8 the Commissioners in Lunacy investigated King’s case, after the patient wrote to the Home Office saying he had not been allowed to visit two dying relatives: a request the Hospital claimed neither the patient nor his relatives had ever made.

With the medical officers checking his post, King made full use of his legitimate channels of communication: the Home Office, the Commissioners in Lunacy, and his solicitor. To the latter, he frequently sent bulky packages, containing letters to be passed on elsewhere (much to the despair of his doctors, who regularly lamented his ingenuity in bypassing their regulations), or advertisements to be placed in the press. In late March, for example, one of these appeared in the Morning Post, asking “parents and guardians” to provide “steady well-educated Young Gentlemen as ARTICLED PUPILS for five years” for a “high-class sixpenny illustrated paper” he wished to start up.

King’s frequent letter-writing was sometimes an embarrassment to the Hospital: in particular, when the patient received a letter from the Home Secretary asking him to give evidence in an enquiry into Holloway Sanatorium, but nothing official was sent to the Hospital. From the tone of the case book, it seems that the medical officers may have found some truth in King’s contention that “the Home Secretary looks upon us [i.e. the Hospital staff] with contempt”.

Edward King was discharged well, just four months after admission, although his life immediately following release does not seem to have been an easy one. It was later recorded that he had spent time in several prisons, and he returned to Bethlem at least once, to try and borrow £1 (which was refused). Although the level of correspondence King maintained while at Bethlem was unusual, his case is a particularly strong example of that way in which, even when certified, a late-nineteenth century patient might still interact to a considerable extent with the world beyond the asylum.

In the Frame for May 2013

This month, the Friend’s Secretary has chosen to highlight a painting displayed at the recent Museum of the Mind exhibition at the Bethlem Gallery: Russell Barton’s Potential Murderers?  The sheer size of this picture means that it is rarely possible to display it at present, but it provides an interesting talking point. One interpretation, used in the exhibition, is that the painting questions one of the common public misconceptions surrounding mental ill-health. The “potential murderers” of the title might thus refer to the seated figures of patients along the wall, the bowed heads and subdued attitudes indicating how ludicrous the generalisation can be. As Barton himself apparently said, “In our mental hospitals today, there are thousands of harmless patients, people who have never done harm, people who never will do harm.”

Yet the figure of the nurse in the foreground is the first thing that draws the viewer’s attention, her face cold and unsmiling, perhaps ignoring those in her care. Meanwhile, the stark walls of the institution fill most of the background: perhaps it is this, and those who run it, that is suggested to have the potential for murder. Barton, who died in 2002 after a lengthy psychiatric career, was an advocate for community care and asylum closure. His key textbook – Institutional Neurosis – argued that asylum care generated a neurotic condition in patients over and above their original ill-health. Colleagues considered that Barton’s experiences at Shenley and Severalls Hospitals (following his training at the Maudsley under Aubrey Lewis) encouraged this thesis: this painting was probably painted during his time at the latter, in the 1960s. The extreme nature of the painting’s title might also reflect the doctor’s early experiences: as a medical student, in the aftermath of the second world war, he volunteered to attend the survivors at Belsen, one of the most notorious Nazi concentration camps.

The starkest contrast in the painting is that between the muted colours of the hospital walls and the bright blue and green landscape beyond. One lone patient stares, perhaps wistfully, through the railings at this apparent utopia beyond. A rather romanticised view, perhaps, reflecting the hopes of those who fought to close asylums in the late twentieth century. An addition to Barton’s obituary in The Psychiatrist, from a friend and colleague, noted that “He never regretted his role in the deinstitutionalisation movement, although he recognised, like the rest of us, that the actual performance fell well short of what he would have wished to see happen.”¹

1 Miodrag Ristich, “Obituary of Dr Russell Barton” The Psychiatrist (2003) 27: 196.

Hospital Snapshots 6

One of the aspects that make the Hering collection fascinating is how much they resemble portraits, either painted or photographic, rather than institutional mug shots.  For the most part, the clothing, pose and objects would not look out of the ordinary in a conventional portrait of the time.

Photography, as a new medium in the late 1850s, may well have been something of a novelty for the type of patient Bethlem admitted.  To have a photograph taken in this early period might have been seen as a mark of distinction. Queen Victoria herself had been photographed and the photographic series ‘Living Celebrities’, published monthly by Maul and Polybank, depicted key individuals such as politicians, churchmen and writers, alongside their biographies.  Bethlem’s patients might not only have enjoyed the experience of a photographic session, but have had their own ideas about how they should be shown according to the photographic conventions as they understood them.

As in painting, clothing is an important indicator of circumstance, individuality and taste.  Although the hospital did not issue clothing, for patients choice may have been somewhat limited.   A number are wearing dresses of the same material and style, perhaps because Bethlem bought in fabric and ‘sewing parties’ were held in which the female patients could make  or alter their own clothing.  Despite these constraints many of the photographs show touches of refinement and personality, perhaps giving a hint to the individual themselves.

The patient we know only as EA is dressed as a respectable, middle class woman.  Her clothes are neat and well made but not showy, the material good but not expensive.  Her hair is firmly tied back, though unusually not covered.  There are touches of decoration such as the ruffles on the sleeves of the dress, lace collar and cuffs.  A fringed shawl is draped around her.  She has taken care over her appearance.

In other photographs, clothing and occupation are more closely allied.  Edward Oxford, the would-be assassin of Queen Victoria, is shown here as if taking a break from his decorating.  He appears to be dressed for the task in hand, wearing a painting overall on which can be seen some traces of paint.  Though the shirt underneath looks fairly standard, the tie appears worn for the occasion.

Clothing was clearly, at least to some extent, within the control of the sitter and helped give personality to each image; next month’s post will consider pose and props.

From Melancholia to Prozac: Depression throughout History

As the new Bethlem Museum of the Mind will reflect on, Bethlem – or Bedlam – continues to loom large in the public imagination, often as a lens through which ideas about mental health care and treatment are cast. That this is the case for researchers as well as journalists is aptly illustrated in a recent book by Clark Lawlor, From Melancholia to Prozac.

Lawlor refers several times to the “enduring” image of public visiting to eighteenth-century Bethlem, which he describes as “a combination of prison and freak show”.¹ He uses this to contrast with nineteenth-century claims to offer “moral treatment” (as, indeed, asylum reformers did in the 1830s and ‘40s). Both ideas he seems to accept at face value, something that we at the Archives and Museum certainly remain wary of: championing or demonising the past can easily serve modern agendas.

Indeed, the main problem with Lawlor’s book is a frequent lack of critical historical thinking. As part of a project to explore depression before this modern label was applied, Lawlor retrospectively diagnoses various historical conditions as equating with modern depression. Many historians of psychiatry would argue against viewing clinical depression as the same as melancholia, hypochondriasis or neurasthenia (all terms used in the past to describe conditions that had some association with low mood). This is not to say that any of these states of illness are somehow imaginary: simply that prevailing cultural and medical concerns impact on not only the ways in which they are described, but also how they are experienced.

One particular example offered by Lawlor, acedia, is a case in point. When medieval monks were suffering from this condition, the low mood and lethargy they descibed might well be described as depression today. However, this was certainly not the most important component of acedia to these monks: most prominent was the loss of spiritual and religious feeling, something which had previously dominated every activity of their daily lives in an isolated monastery. Even the most devout person in the modern world is unlikely to put such an all-encompassing emphasis on spiritual connection today, and therefore cannot experience its loss in the same way that a thirteenth-century monk would have done.

Back to Bethlem, and Lawlor reproduces an image of Cibber’s famous statues, using them to claim the physiognomic emphasis on diagnosing depression in the late seventeenth and early eighteenth centuries. Yet, on viewing the original statues, school groups at the museum frequently comment that “Melancholy Madness” doesn’t look sad to them. Might different facial expressions have meant different things to people around 1700? Might they have associated other emotional experiences than sadness with melancholy, such as the fear highlighted in the Carnival of Emotions? We certainly cannot be certain that clinical depression is the culmination of one universal story of understanding extreme misery.

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1 Clark Lawlor, From Melancholia to Prozac (Oxford: Oxford University Press, 2012), p. 80

Sketch of a woman diagnosed as suffering from melancholia.

Lithograph, 1892, after a drawing made for Sir Alexander Morison (Wellcome Library, London).

held by Jane Fradgley: A Symposium on Restraint

On the evening of 31 July, the MRC SGDP Centre at the Institute of Psychiatry and the Damaging the Body seminar series will co-host a public symposium on the topic of restraint and strong clothing in mental health care. This event accompanies artist Jane Fradgley’s held exhibition, on display in the foyer from 10th July to 27th September. This series of striking photographs of garments from the Bethlem collection was funded by Guy’s and St Thomas’ Charity and, as previously noted on this blog, the artist has captured these late nineteenth and early twentieth-century garments in a very different manner from the usual methods of displaying such objects (previously explored in Curatorial Conversations IV).

The exhibition is currently on display at Plymouth Arts Centre (until 16 June). However, Jane’s photographs have already opened up debate around the topic in London. Last year, the Bethlem Gallery hosted a focus group on “strong clothing”, bringing together a variety of people within the mental health field: service users, clinical and curatorial staff, therapists and art practitioners. The garments and their history were exhibited, and a lively debate explored the various forms of coercion adopted within contemporary health care and the relation of the historical garments (and their display) to this context.

The term “strong clothing” was used by late nineteenth-century psychiatrists to refer to garments used in English asylums to restrict movement. These doctors wished to distinguish the clothing they used from the “revolting instruments of mechanical coercion” rejected by the “non-restraint” movement of the 1840s and ‘50s. While English asylum superintendents at this time claimed to have abandoned all methods of mechanical restraint, physicians of the 1880s and 1890s re-introduced restraining garments by claiming them to be something else entirely. Strait-jackets (generally known as strait-waistcoats) and handcuffs were replaced with “strong dresses” and “padded gloves”, placed on a relatively small number of patients to prevent self-inflicted injury or the destruction of clothing and other items. By the turn of the twentieth century, however, strait-jackets appear to have returned to some institutions.

Today, it is often assumed that the exhibition of restraining garments will be distressing to viewers: a stark reminder of past cruelties. Participants in the focus group, however, exposed a much more nuanced view of these items. The forthcoming symposium will invite a wider audience - including clinicians, historians, artists and service users - to explore what restraint is, and how (and if) we can ever draw a line between care, cure and control. Following short presentations from a variety of practitioners, the debate will be opened up to the audience.

Tickets are free, but places are limited and must be booked in advance at: heldsymposium.eventbrite.co.uk

Doors will open at 5pm, with a reception and chance to view the exhibition. The symposium will begin at 6pm, ending by 8pm. The artist will be releasing a book associated with the exhibition later in 2013, funded by the Maudsley Charity.

Location: MRC SGDP Centre, Institute of Psychiatry, King’s College London, 16 De Crespigny Park, Denmark Hill, SE5 8AF (within the Maudsley Hospital site).