In the Spotlight: Introduction

People often ask us, ‘Have there ever been any famous patients (or, any notorious patients) at Bethlem or the Maudsley?’ It is a question we struggle to know how best to answer. Certainly mental distress is no respecter of persons, so over the years one would expect a small percentage of hospital admissions to have been of those in the public eye for one reason or another. (Brian Moody’s photographic 1 in 4 exhibition is a near-contemporary reminder of this.) But the question seems to reflect an intrusive obsession with celebrity, not to mention a disregard for privacy, which we find ourselves reluctant to affirm or encourage. It should go without saying that the medical confidentiality of those admitted within living memory is inviolable.

That said, the Archives & Museum is in a unique position by virtue of its collections to record the lives and experience and celebrate the achievements of people who suffer, or have suffered, mental health problems. One small way we have sought to do this is by highlighting an artwork from our reserve collections in our monthly In the Frame post. This year we will add a new series of posts to this blog about people of previous generations who spent time as Bethlem or Maudsley Hospital patients, but whose lives became defined, at least in the minds of others, by their achievements rather than by that experience. A few of those we feature will be familiar (if not actually household) names. All deserve to be better known.

We will restrict ourselves to those admitted to Bethlem or the Maudsley between (say) 1840 and 1939, as earlier patients of note are featured under the ‘patients’ tab in Visiting Bethlem. For the purpose of this series of posts, we will also exclude artists whose work is represented in our collections here at the Archives & Museum – with one exception, which will be explained in due course.

Gender and Madness in Post-War Bethlem: A Meeting of Minds?

World War Two has been depicted as an era of innovation, professional growth and public acceptance for British psychiatry. Nevertheless, in the psychiatric treatment of women, ‘progress’ may have been transient: they have been considered more susceptible to insanity due to supposed biological propensity or exacting social expectations. Clinically, a rising tide of voluntary admissions from the 1930s coincided with the emergence of ‘psycho-neuroses’, a category in which women were over-represented. Women also outlived and outnumbered men, and gender disparities in admissions were subject to preferences of GPs and other ‘gatekeepers’. Whilst some evidence also links male admissions to transgression of stereotyped career norms, this finding is obscured by historical emphasis on female patients.

The gendered experience of mental health was amongst issues debated at a recent conference on the history of post-war women’s health, hosted by the University of Manchester’s Centre for the History of Science, Technology and Medicine. Emerging research based on analysis of primary source material used Bethlem Hospital as a case study for exploring similarities and differences in the experiences of male and female patients in this period. Admission register and casenote data provided a unique glimpse into prevailing theories of mental illness, and the changing character of the hospital and its patients. This was complemented by interviews with former Bethlem staff.

Key patterns were identified in the demographic composition of Bethlem’s patients, diagnostic practices and treatment delivery, with discussion of how these characteristics evolved over fifty years, against a wider backdrop of legal, social and scientific change. The findings chiefly indicate a postwar convergence, and, in some cases, reversal, of traditionally ‘gendered’ diagnoses – such as anxiety – and the ascent of ‘affective psychosis’ (e.g. manic depression) amongst women. This was countered by a widening age disparity between male and female admissions, most prominent within the over-60 age groups, where a middle-class bias remained apparent. Although the psychological effects of marriage are unresolved, the research suggested that women may also benefit, and that in this area too, the experiences of men and women had more in common than has previously been acknowledged. Finally, investigation of psychotherapy services is shedding further light on how shifts in theory and practice affected the hospital’s population and recovery rates.

Although one should not over-generalise from case study evidence, it is very striking that the Bethlem data do not conform to gender dichotomies of mental illness established in both academic discourse and the popular imagination. This, in itself, highlights the value of such research in deconstructing accepted accounts of male/female disparity in psychiatric experience and the need for continued engagement with documentary and oral histories of mental health care.

The programme for the conference, which took place last month, is
available on the University of Manchester website.

Getting into Georgian Bethlem 3

In previous posts we described the restrictions placed on admissions to Bethlem Hospital, and to its ‘incurable’ ward, in the eighteenth century, and told the first of two stories of attempts made to gain admission for a patient. The second concerns Sarah Lufkin of Little Bentley near Manningtree, Essex, who came into the Hospital on 16 February 1782, and was discharged uncured on 15 February of the following year, in strict accordance with the previously-described rules governing admission and discharge. Mrs Lufkin was considered a ‘fit Object’ for transfer to Bethlem’s ‘incurable’ ward, but had to go on the waiting list for a vacancy. It took seven years for her to be offered a place, and a letter written to the Hospital by Sarah’s son John Lufkin is preserved in the archives.

‘My Brothers, Sisters and myself have Deliberated on the matter,’ John wrote, ‘and although her who has been one of the tenderest Mothers still continue in a state of Insanity, I leve [sic] you to judge from your own feelings if it would not be a heard, very heard work for us to part from her and perhaps never to see her more.’ This was no exaggeration on John’s part. Little Bentley was at least two days’ coach journey away from London in the eighteenth century, and the fare was not cheap.

By 1790 Sarah Lufkin’s children had been seven years without Bethlem’s assistance in caring for her. ‘Ever since she left London she has been in a very Creditable Famaly [sic] where she is treated with the greatest kindness and has every Indulgence a person in her Situation can have, and where we can see her as often as we please as the Distance is only half a mile from our own Famaly.’ What would they do, then, with Bethlem’s renewed offer of help?

‘Although it is a very heavy Expence’, John Lufkin continued, ‘we hope with the Blessing of God to be able to support her till it shall please the Lord to release her from her heavy affliction, for can we do two [sic] much for a good Parent’? That John Lufkin’s filial devotion was shot through with practicality is evidenced by the next (and effectively last) line of his letter: ‘Sir, if we omit this opportunity and if at a futer [sic] time any thing unforeseen should happen so that we find the Expence more than we are able to support, could she then at a Vacancy be admitted’? No record survives of the answer given by the Hospital, but we may surmise that, if that it stuck by its rules, the answer would probably have been ‘No’.

Getting into Georgian Bethlem 2

Correspondence between two eighteenth century solicitors, currently being edited for publication by the Sussex Record Society, provides an unexpected insight into how the rules of admission to Bethlem Hospital (described in an earlier post) functioned in practice at that time. We are grateful to the editor of these letters for drawing our attention to this example, and for permission to cite it here.

On 12 November 1745, James Collier of Hastings wrote to John Collier ‘in relation to the unhappy affair of Mary Cousens, whom my uncle and I though a proper person’ for admission to Bethlem.

‘I shall be able I beleive [sic] to have some respite in regard to her removal, and when the committee are known, shall endeavour to get her minuted down for the ward of the incurables which depends principally upon the report of Dr Monro; and I am glad to find that our case, viz. a raving madness, is a circumstance that particularly induces the committee to send such poor people there.’

In seeking a place for Mary Cousens at Bethlem, Mr Collier was acting as a professional agent of the Hastings authorities legally and financially responsible for the care of all ‘pauper lunatics’ resident within their parish boundaries. His communications with Bethlem’s Physician, Dr Monro, seem to have been conducted via a third party. At any rate, he had been poorly advised. As noted in the previous post in this series, in the ordinary course of events patients were not admitted directly to the ‘incurable’ department, and people judged ‘incurable’ would not be admitted to the Hospital in the first place.

While he hoped for a Bethlem admission for Mary, James Collier did not put all his eggs in one basket. ‘By next post, I shall be able to acquaint you with certainty what will be done as to Guy’s hospital,’ his letter to John continues. ‘They never suffer anybody to enter there, who has once been in bedlam, and I am afraid private madhouses will be attended with great expence.’

How did matters turn out? From a second letter, written by James Collier to John nine days later, it appears that Mary lived under Bethlem’s roof while being assessed for admission, but was not in the event admitted. ‘Mary Cousens is not as yet removed out of Bethlem hospitall [sic], but it is impossible to get her continued there’, he writes. ‘Mr Alnright of Lambeth marsh will take her for one month upon trial for 8sh per week, but if her distemper is such as to require a more than ordinary attendance, he will have more.’ With an eye to parish finances, Mr Collier would have preferred Bethlem to relent, an outcome for which he continued to hope against hope. ‘I don’t despair at present of getting her minuted down in the list of persons who are to supply the vacancys in the ward of incurables.’ In the event, however, Mary Cousens’ name does not appear in any of the Hospital’s admission registers, incurable or otherwise. Where she went, we cannot say.

The Bethlem Tapestry: World Mental Health Day 2010

A new exhibition is now open at the Bethlem Gallery, the result of a project led by artist Mark McGowan, and involving patients, staff, volunteers and carers at the Bethlem Royal Hospital Psychosis Unit. The tapestry, the culmination of a six month project initiated by Consultant Psychiatrist, Dr Sukhi Shergill, has been created on ten metres of stretched silk. It is comprised of images and text made by the participants depicting experiences, thoughts and feelings in their daily lives over the period of the project and will be permanently installed on the ward for the long-term enjoyment of patients, visitors and staff.

Well-known London performance artist, Mark McGowan is a former patient of the Bethlem Royal Hospital. Mark described the tapestry project as an opportunity to give something back to the Bethlem Royal Hospital, part of the South London & Maudsley NHS Foundation Trust (SLaM). “I was very ill and came to SLaM in a really bad state. As a patient I was given access to the arts facilities and never looked back.”

Since leaving the Bethlem, Mark went on to complete an art degree and now teaches at Chelsea & Camberwell Colleges of Art, having travelled the world through his art projects. The Bethlem Tapestry has proved popular with patients and staff. Ken, a patient on the Psychosis Unit, said the project made him feel happier and more relaxed, “Anyone was welcome to join in, we had something to do, something productive using the imagination.”

The exhibition coincides with World Mental Health Day on 10 October 2010: the Gallery and Museum will both be open on Saturday 9 October in celebration. Running since 1992, World Mental Health Day aims to promote greater public awareness and understanding of mental health and mental illness.

Exhibition open: 23rd September – 15th October 2010

Wed, Thurs, Friday, 11am – 6pm
(including Saturday 9th October 11am – 6pm, celebrating World Mental Health Day 2010)

For travel information, visit the Bethlem Gallery website.