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.

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.

Sign the Visitors’ Book, Please

Anyone who has made the trip to the Archives & Museum will know that one of the first things they are invited to do is sign our visitors’ book. This is old  - pen and paper – technology, but effective enough in affording visitors the opportunity to sign up for our quarterly email newsletter (which can also be done by filling in the box near the top right of our homepage or leave comments, as well as in providing raw data from which we can extract annual visitor numbers. Perhaps in one hundred years’ time, historians of the future will use these books to find out about museum visitors of the early twenty-first century? After all, what we did on last year’s Just Visiting thread was not all that different. Its focus, though, was on visitors to Bethlem Hospital in the last half of the nineteenth century, and early part of the twentieth.

In using the Hospital’s Visitors’ Books of that period for this purpose, we encountered an intriguing fact. While many of the people who visited the Hospital signed the book, others – unaccountably – didn’t. The result is that, while the Visitors’ Books can – and have – been mined for information concerning who visited, the absence of a name is not proof conclusive that no visit was paid. Sometimes we know, or may fairly assume, from other sources that a person whose name does not appear in the books did actually make a visit: Charlotte Brontë, for instance. Yet she was not the only one.

Two German cases illustrate the point. The Frankfurt psychiatrist, children’s author and civic dignitary, Heinrich Hoffmann (1809-1894) visited Bethlem in June 1856. Thirty years earlier – in April 1827, to be precise – the Paris-based poet Heinrich Heine (1797-1856) also paid a visit. This much can be established from published sources: Hoffmann’s autobiography, and Fritz Mende’s biography of Heine (citing a letter of his), respectively. Hoffmann duly wrote in Bethlem’s Visitors’ Book; but – frustratingly, and for reasons unknown to us – Heine didn’t. Consequently, when Frankfurt’s Historisches Museum mounted an exhibition in commemoration of the bicentenary of Hoffmann’s birth, a facsimile of the page of the book on which he signed was included in it. By contrast, there was no paper trail for the compilers of the final volume of the modern, German-language edition of Heine’s works (currently in preparation) to follow.

All of this goes to show that signing the book was something that people opted into (or opted out of) back then, as indeed it is now for visitors to the Archives & Museum. No doubt there have always been some for whom the merits of anonymity trump the claims of posterity.