Madness and Literature 2: “A Hideous Torture on Himself”

When not working at the Archives and Museum, the part-time Friends Secretary is also researching the nineteenth century casebooks. She presented at the Madness and Literature conference, examining representations of self-mutilation (a term introduced and defined by psychiatrists, including Bethlem superintendents George Savage and Theo Hyslop, in the 1880s) in nineteenth century literature and psychiatry. The title bears reference to Nathaniel Hawthorne’s The Scarlet Letter, first published in 1850. Set in puritanical seventeenth-century Massachusetts, the novel tells the story of the punishment of Hester Prynne, forced to wear an embroidered “A” on her chest (the “scarlet letter” of the title) as punishment for having borne an illegitimate child. At the close of the novel, this “A” is exhibited burnt into the chest of the Reverend Arthur Dimmesdale, publicly revealing him to be the child’s father, made physically and mentally ill through the long-guarding of his guilty secret. In Hawthorne’s work, the origins of the wound are debated, although to late nineteenth and early twentieth century psychiatrists, as well as certain of the spectators described by Hawthorne, the only “rational” explanation was that Dimmesdale’s self-punishment had been “followed out by inflicting a hideous torture on himself.”

Although Hawthorne’s representation of Dimmesdale was certainly not intended as a medical case history, the case was referenced by medical writers who had no problems with what some later authors, including Henry James, saw as a crude use of symbolism in an otherwise psychologically interesting novel. Indeed, many nineteenth century medical writers on self-mutilation expected their patients’ acts to be similarly symbolic, analysing motives and “hidden meanings” in a manner often starkly at odds with that in which other problematic behaviours were portrayed (in the Bethlem casebooks, refusal of food or persistent removal of clothes, for example, is usually simply dismissed as troublesome).

We can find many examples in the Bethlem casebooks of these attempts – by patients and practitioners – to give meaning to self-damaging actions such as face-picking, hair-plucking and self-cutting. In 1889, James Hipwood’s attendant stated that the former had cut his face because “he liked to see the blood that followed.” To his mother, meanwhile, Hipwood said that he cut himself because “he wanted to see if he could feel anything.” Yet, in Bethlem, an alternative explanation was implied. Although the doctors found it hard to get anything out of their patient at all, he did tell them “that he does not want to live & hints at something dreadful that is going to happen & at great suffering which he will have to bear.” The medical officers suggested that “he is apparently trying to prepare himself [for this] by inflicting pain on himself now.”

Photograph of Mary Stoate, admitted to Bethlem in 1895

Bedlam at the Globe Theatre

The Archives & Museum was recently visited by the cast of the forthcoming production at Shakespeare’s Globe, Bedlam. Playwright, Nell Leyshon, covered her own visit in an article in The Evening Standard (read it here): interestingly her conclusions bore remarkable similarity to those of the Illustrated London News correspondent who visited Bethlem in 1860. Remarking on what he saw as evident progress in the Hospital since the eighteenth century, this could do little to fill “the vast abyss of human mental misery.”

We should remember that the progress remarked on in 1860 reflected much wider changes – in medical treatment (with the declining popularity of bleeding and purging as a standard response to both physical and mental disease), and the growth of the county asylum system, and an increasingly bureaucratic and professionalised mental health field. For some, however, seemingly outdated treatments continued popular: in 1860, one 38 year old housewife at Bethlem demanded to be cupped and bled “as the only means to relieve the distress of her head.” The medical officers did not comply with her requests.

Yet, it seems fitting that Leyshon’s play reflects the use of the word ‘Bedlam’ in the Globe’s heyday. In the 1600s, the term entered popular parlance as a general term for insanity, chaos or riotousness, as well as referring specifically to the Hospital and its former inmates. In Shakespeare’s King Lear, Edgar disguises himself as a “Tom o’ Bedlam,” a common term to refer to former inmates who might subsequently become wandering vagrants, while the Hospital itself appeared in the early Jacobean satire, Northward Ho, written by Thomas Dekker and John Webster. Such plays tend to provide romanticised or exaggerated views of asylums and the mad, for dramatic effect, humour, social commentary or political allegory. They provide better insights into the fears and obsessions at large in the world outside the hospital, than they do about conditions that actually obtained inside it.  Plus ça change, plus c’est la meme chose.

Bedlam, by Nell Leyshon, runs from 5 September to 1 October at Shakespeare’s Globe, complemented by an art exhibition previously on show at the Bethlem Gallery – Portraits: Patients and Psychiatrists.

Madness and Literature: First Annual Health Humanities Conference

We’re excited to see that the programme for the First Annual Health Humanities Conference on “Madness and Literature” has been announced, with a fascinating array of keynote speakers, panel sessions and poster presentations. Papers include Samantha Walton’s ‘Guilty But Insane: Psychiatric Detectives in the ‘Golden Age’;, Sonja Deschrijver’s ‘The Devil in Writing: Malady, Mind and Medicine in Early Modern Spiritual Text and Criminal Trial Proceedings’ and Dr Caroline Logan’s ‘La femme fatale: The Female Psychopath in Literature and Clinical Practice.’ Bethlem also finds representation: two papers discuss the work of Samuel Beckett, inspired to write Murphy and Watt by a visit to the Hospital in the 1930s, while Sarah Chaney’s paper on self-mutilation in Victorian fiction, “A hideous torture on himself,” is grounded in research into the Hospital’s 19th century casebooks.

Taking place in Nottingham from 6-8 August 2010, the conference is hosted by the Institute of Mental Health at the University of Nottingham, as part of an AHRC-funded project, the Madness and Literature Network. The Network aims to stimulate cooperation and co-working between researchers, academics, clinicians, service users, carers and creative writers in order to develop an interdisciplinary, global dialogue about the issues raised around representations of madness in literature: the Conference will bring together speakers from the humanities and clinical backgrounds to aid this collaboration.

Our readers may be particularly interested in the conference’s keynote speakers. On Friday 6 August, Kay Redfield Jamison, a leading expert in mood disorders, will discuss ‘The Consequences of Writing a Memoir about Madness.’ Kay’s autobiography, An Unquiet Mind, documents her personal battle with Bipolar Affective Disorder (BPAD), while Touched With Fire examines manic-depressive illness and the artistic temperament: her presentation promises to be engaging and insightful. On Saturday 7 August, Elaine Showalter, author of the influential The Female Malady, will provide a cultural perspective on ‘The Grand Delusions.’

You can find the full conference programme and registration form on the Madness and Literature website. Several free places for service users and carers remain: interested parties should contact Charlotte Baker for details (email address can be found on the homepage of the Madness and Literature site).

Life in a Victorian Asylum 1

Following investigation and subsequent reform in the early half of the nineteenth century (1815 and 1852), Bethlem Hospital increasingly became a very domestic environment, as pictured in the Illustrated London News in 1860. The accompanying article attributed the changes in the Hospital entirely to Bethlem’s new “skilful and benevolent” resident-physician, W. Charles Hood, appointed in 1853; however, the published annual reports show that a large number of changes had already been made under the previous charge of Sir Alexander Morison and Edward T. Monro, the visiting physicians. In 1845, they reported that “much attention has been paid to the amusements of the patients during the past year. The library, billiard and bagatelle rooms are very generally occupied on the male side by the better classes, and much interest excited by books, cards and games.”

These additions to activities in the Hospital, and improvements in the therapeutic environment, were continued by Hood, who adhered strongly to the twin ideals of moral treatment (cure through re-education, with a clear emphasis on environmental and occupational, rather than strictly medical, therapies) and non-restraint (complete abandonment of any type of mechanical restraint, including straps, straight-waistcoats etc. Seclusion, however, was permitted).

Hallucinations and Delusions

The Bethlem Archives contain 450 years of material, including committee minutes and papers dating from 1559, as well as financial, administrative and clinical records, correspondence, private papers, reports and photographs for much of the history of the Hospital. The amount of material created and stored expanded in the nineteenth century. In 1853, Bethlem became subject to the Lunacy Acts (1845), which heavily regulated the numerous county pauper asylums and private “madhouses” built by this date. Patient casebooks had to be regularly updated, and many records are detailed, providing fascinating insight into nineteenth century culture and society, as well as life in the asylum and individual patients (NB. Only cases dating from over 100 years ago are open to public inspection). The Notes from the Archives series, penned by one of our researchers, will cover some of these insights.

Nineteenth century asylum medical officers – or alienists, as they were often known – showed particular interest in the content of the hallucinations and delusions of many of their patients. From the early 1880s, these had to be recorded in detail by a medical officer on admission of the patient to Bethlem – information was also requested during an interview with a relative. From 1886, hallucinations were divided into those of sight, hearing, taste, smell and “common sensation,” while delusions included those of exaltation (such as belief in special or superior powers) and depression (most commonly religious loss or worldly ruin), as well as delusions relating to food, which often resulted in a patient refusing to eat. Some delusions are specific, and indicate particular themes or events and the ways in which they were picked up by Victorian society.