Symbolic Abstractions: New Gallery Exhibition

This week, a new exhibition of paintings, drawings and sculpture by Peter Rowbotham opened at the Bethlem Gallery. Peter lives and works in Croydon and is a former patient of Bethlem Royal Hospital. He has been making artwork since he was a child. He studied at Goldsmiths College and Hammersmith College and among his influences are Mark Chagall and Pablo Picasso. Peter has experienced mental health problems since his twenties, and has been in and out of hospital care for most of his life. His artwork is an important part of his life and helps him to keep well. He attributes his graphic style to his years working in the screen printing trade and the narrative element of his work to his life experiences.

Exhibition open: 27th July – 20th August
Wednesday – Friday, 11am – 6pm
and Saturday 7th August, 11am – 6pm (Museum also open on this date)

“My work comes from my imagination and memories of people and places I
have seen. I paint and draw juxtaposing images to represent feelings and
emotions.”

Life in a Victorian Asylum 2: Clerks and Governesses

While certainly connected to moral treatment, improvements at Bethlem were presumably also related to the changing patient profile: throughout the nineteenth century the Hospital became increasingly middle class – by the 1860s, the majority of patients tended to come from lower middle and “educated” working class backgrounds. As Hood lamented in 1854, “The records of all Asylums show how liable are clergymen, authors, artists, governesses, professors and similar persons to be attacked by this terrible calamity. None are more subject to this visitation, none are less able in a pecuniary point of view, to struggle through the trial of such an affliction, yet none are less cared for by the many charitable institutions of our country.” This changing patient profile is indicated in the admissions: 10% of male admissions to Bethlem in 1845-55 were clerks (compared to just 0.01% of the population), while 7% of female admissions were governesses or school mistresses (again, just 0.01% of all women were governesses).

In reflection of this changing class of patient, the Hospital’s wards increasingly came to resemble the Victorian domestic ideal: as the Illustrated London News put it, “that which was once a prison-cell has now become a cheery, domestic room,” while Freeman’s Journal later described photographs of the late nineteenth century hospital as “luxurious” and of “hotel-like magnificence.” This was in line with similar changes described at St Luke’s by Charles Dickens, in his article A Curious Dance Round a Curious Tree. Nonetheless, most contemporary observers were aware that these changes might be little consolation for many patients. As the correspondent from the Illustrated London News concluded: “I thought of the luxuries and the comforts, the plants and the pet animals, the books and the periodicals, the billiard and the ball room, the skill and tenderness of the physician; but all these, to my mind, would not fill up the vast abyss of human mental misery yawning beneath the lofty dome in St George’s fields…”

The Future of Medical History

The Future of Medical History conference, organised by the soon-to-be closing Wellcome Trust Centre for the History of Medicine at UCL took place last week. The history of psychiatry and psychology was certainly high on the agenda, with papers on the topic ranging from music therapy in eighteenth century medicine, through the role of psychical research in nineteenth century scientific psychology, to a new take on the link (or, as was argued, the lack of one) between melancholia and clinical depression: if nineteenth century diagnoses of melancholia were specific to the period, our theories of clinical depression must also be reinterpreted.

These contributions, including a paper on post-war psychiatry in the United States by Professor Andrew Scull, a central figure in twentieth and twenty-first century history of psychiatry, indicate that psychiatric history certainly has a promising future. Indeed, one persuasive session on the importance of collaboration in medical history, reminded us of the need for historians to work together – and with those from other disciplines, including clinicians – to improve our understanding of the field. In the final paper of the day, Professor Sander Gilman reminded us that the role of the historian is never to stop asking questions, of him or herself as well as sources. Nonetheless, as post-paper discussion highlighted, such attempts do not have to be destructive. The future of medical history, it was suggested, lies in construction, an irony that will not be lost on those at the Centre, the announced closure of which came as a shock to medical history in April.

Visit the Friends of the Wellcome Trust Centre for the History of Medicine blog here.

DSM-1907: Diagnosis in the Edwardian Era

The fourth and current edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders list 297 disorders or diagnoses. A fifth edition is in preparation. The history of psychiatric pathological classification is controversial and contested. The most dramatic visual statement of its pre-history on this side of the Atlantic must be Caius Gabriel Cibber’s statues of ‘Raving and Melancholy Madness’ (featured on Bethlem blog at the start of May 2010) which once dominated the entrance to Bethlem Hospital and constituted part of the iconography of the city of London, and are now on display in the Archives & Museum. ‘Mania’ and ‘melancholia’ were the two syndromes rendered in Portland stone by this ‘DSM-1676’.

A more elaborate, and more recent, diagnostic effort is represented by the Schedule of Forms of Insanity first issued by the Lunacy Commissioners (later the Board of Control) in 1907. The Lunacy Commissioners governed admission to and conditions within the asylums of England and Wales by a system of regulation, inspection and tribunal, and published annual reports containing reports and statistics on mental health. >From 1907, the Commissioners required asylums to record diagnostic details in conformity with their Schedule. (Parallel developments in the United States of America are described in the introduction to DSM-IV TR.) Register entries on ‘manic’ patients were coded II.8 a. b or c (a for recent, b for chronic, c for recurrent) thereafter. Entries on patients suffering ‘general paralysis of the insane’ were coded II.2. And so on. Without the codes in the Schedule, some of the details given in the asylum registers of the early twentieth century are difficult, if not impossible, to interpret.

Now that these codes (and a number of the asylum registers in which they were used) are over one hundred years old, the Health Archives and Records Group of the UK and Ireland have published a version of the Schedule online (at www.healtharchives.org). This publication opens a window not only onto asylum register data, but also onto the theory and practice of psychiatric diagnosis in the Edwardian era.

Bethlem Sunfayre: History, Art and Plenty of Sun!

Well, the weather turned out beautiful for the Sunfayre last Saturday, 10 July. So, on a wet and dreary Tuesday morning, let us transport you back to the gloriously sunny weekend, where those who came on our historic tours of the site needed parasols rather than umbrellas! A big thank you to everyone who visited the museum and archives, and participated in our talks and tours in the education room. We had nearly 300 visitors in total, a remarkable number given the small physical size! Most of the visitors were local, and many had strong connections to the site: we met former Bethlem employees who were fascinated by the history, or those who had been previously treated or visited relatives under treatment here. Others found the event, particularly the guided tours, reassuring, remembering previous concerns in the local press but never having been to the site before.

As well as viewing an exhibition of Louis Wain’s anthropomorphised cat paintings in the museum, huge numbers of visitors attended talks on the history of the hospital: ‘Meet a Victorian Patient’, and ‘Bethlem Patients in the 1850s’. The studio portraits of patients on the walls of the education room fascinated many. Photographed by Henry Hering, a well-known society photographer, in the 1850s, many of the images come in pairs to show a patient during their illness and following recovery. The education officer explained that this was perhaps an attempt to understand insanity through the comparison of facial expressions and posture. The talk was followed by a guided tour of the site, led by the head of the Archives & Museum. The tour offered a rare opportunity to visit the Hospital’s historic boardroom, as well as taking in Dower House, built as a home for the superintendent in the days when he was resident at the Hospital: the remains of one of the Hospital’s air raid shelters can also be seen in the garden. Juxtaposing the old and the new, we passed River House, a state of the art medium-secure unit, opened in 2008, ending at the recently refurbished Walled Garden, an important part of the Hospital’s occupational therapy unit.

One visitor’s experience was not uncommon: “I’ve lived locally for years, and drive past the site all the time, but I never realised it was such a fascinating place with so much history. There should be more days bringing the community in!”

Until next year’s Sunfayre, you can still visit the museum every weekday, from 9:30am – 4:30pm while, from August, we aim to open one Saturday a month (in conjunction with Bethlem Gallery opening): watch this space for more details! You can also arrange group visits to enjoy talks and activities, including those around the Hering photos. For more information, or to book a visit, go to: www.bethlemheritage.org.uk (no booking necessary for individual visitors to the museum or gallery).