Archive for the 'history' Category

Hospital Snapshots 10

Observable evidence was thought to be crucial in documenting changes and determining recovery so drawings and later photographs could be valuable tools. The case of Eliza Ash provides a good example of the type of noticeable change that might suggest progress. There are three drawings of her, made when she was a patient at Bethlem in the 1840s suffering from mania, with brief comments added by Alexander Morison. (see previous month)

Eliza Ash pic. 1

Though some details are similar, she does not look at the artist in any of the drawings for example, some change in Eliza is visible. On her admission she was said to be ‘violent and mischievous, with incoherence of speech’ and the first drawing was made when she was in this state. We have a clear view of her face; her head held at a slight angle so that she is looking down and off to the side. Her mouth is closed but her lips are not pressed together to denote any tension. Her oval face looks longer due to the cropped hair which sits close to her head, well off her forehead, cut round her ears so that both are visible. The overall impression is perhaps of someone lost in their own thoughts.

It is not clear if Eliza is standing or sitting but she has her arms raised and clasped loosely at chest height. Much of her dress is visible but, as is typical with the drawings, it is merely sketched in. It has a high scooped neck unadorned with any type of collar, quite a full skirt and full sleeves which are narrowed to a cuff at her wrist.

Eliza Ash pic. 2

In the second, Eliza is seen in a three-quarters profile. She appears at some distance from us. Her face is rounded and well filled out though the chin is quite defined. Both eyes are visible. She has short styled hair that partially covers the ear. Some, at the rear, appears to be longer or to have come loose and is trailing down her neck. Her mouth is closed. She appears open and relaxed, almost as if she is inwardly smiling, though perhaps at something only she is privy to.

Eliza is wearing a loose fitting dress, not much more than the scooped neckline visible. The impression is of someone sitting rather than standing, perhaps with her hands in her lap. Her posture betrays some tension, the shoulders a little hunched.

Eliza Ash, pic. 3

In the final picture, Eliza appears to be nearer to us, we see her more clearly. The three quarter profile is sharper; on the right only the eye lid and lashes are visible. Everything about the image is more defined; the face has lost some of its roundness, the eyes wider and clearer, the nose more shapely. Once again, the mouth is closed. Her hair, though similar to the first picture, is slightly shorter, revealing the whole ear. It is styled more elegantly, the line perfect.

Eliza’s dress appears more fitted, darts at the front are hinted at. It is trimmed with a narrow white band at the neck. Her body language gives her more of a dynamic air and the impression is one of someone standing with arms at their sides or perhaps loosely clasped in front. This final picture lends her more personality than the first, though arguably she conforms to the nineteenth century ideal of female normality. Everything in it seems to be pushing us towards the conclusion that we only have to look at her to see that she is convalescent.

UPDATE: If you want to help us to bring our photography collection into the 21st century then help us win the chance to work with acclaimed photographer, Rankin by voting here: http://bit.ly/voteBethlem.  We want to use this as a chance to show that you cannot tell if someone has a mental health issue by their appearance.

The Advertisement Archive I

An envelope was recently sent to the Archives & Museum containing a small sample of mental hospital and psychiatric drug advertisements published in the Journal of Mental Science (the forerunner of the British Journal of Psychiatry) in the 1930s and 1940s. Such advertisements were commonly printed at the front and end pages of professional journals. Though the Journal of Mental Science is now available to consult online, the front and end matter of its mid-twentieth century issues have not been digitized, so advertisements like these can only be consulted in libraries that retain print copies of the Journal.

Until now, that is. There is no place in our holdings here at the Archives & Museum for an ephemeral collection like the one that has been sent to us. But we have decided to publish images of these stray pages here on the Bethlem Blog. From now until next June, we intend to show you one each month: hospital advertisements in 2013 – starting today with Holme Lacy in Hereford – and drug and other treatment advertisements in 2014.

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Location, Location 5

The story of Bethlem’s four sites having been told in earlier posts to this thread, the Archivist now turns his attention to the siting of the other hospitals for which the Archives & Museum holds records: Croydon Mental Hospital this month, and the Maudsley Hospital in November.

Until 1903, Croydon Council fulfilled the statutory responsibility, imposed on all local authorities by successive Lunacy Acts, of care for the ‘pauper lunatics’ of the Borough by arranging for their residence elsewhere – notably Cane Hill Asylum, Fisherton House near Salisbury and the Isle of Wight Asylum. Toward the end of the nineteenth century, however, the Council brought forward plans to build an asylum of its own, and bought a seventy-acre acre site for the purpose in Warlingham, six miles south of Croydon.

The Hospital’s first Medical Superintendent was appointed in March 1902, before any patients had been admitted and while building work was still underway, and visited the site regularly to advise the architects “on all details affecting the future working of the Institution, such as the position of telephones, electric bells, tell-tale clocks, disinfector, fire alarms, operating theatre, screens in the corridors, hatchways to the various stores, covering up of all obvious points of suspension…that would act as a help and incentive to suicide”.1

The buildings, according to the Hospital’s first annual report, were “of the plainest and simplest character, all superfluous ornament having been avoided and every part having been treated with a view to economy”.2 The Superintendent noted that the removal of tree stumps and brushwood by the unemployed of Croydon during the winter of 1902-03 “proved a great blessing as regards the aspect and view of the whole Institution” as well as having allowed for “a larger cricket and recreation field, and more land for farm purposes”.3 At that time, 38 acres of land were given over to the cultivation of produce such as potatoes, cabbages and strawberries.4 In this way (and in several others), a self-sustaining element was introduced into hospital life from the outset.

A history of Croydon Mental Hospital (renamed Warlingham Park in 1937) will not be attempted here; for those who are interested, an outline may be found within the Archives & Museum’s This is Your Hospital web resource. Having opened in 1903, the Hospital was closed in 1999. By that time, Croydon’s mental health services had been subsumed into those run by Bethlem and the Maudsley Hospitals. All Warlingham Park’s buildings (save only its distinctive clock tower) were subsequently demolished and the site redeveloped for suburban housing.

1 Croydon Mental Hospital, Warlingham, Surrey: First Report of the Visiting Committee (1904), p. 21

2 ibid. p. 12

3 ibid. p. 22

4 ibid. p. 31

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The Clocktower in 2013

Mansions in the Orchard: New oral history project

We’re pleased to announce that the Bethlem Archives & Museum will be starting a new oral history and photography project, focused on the twentieth century hospital at Monks Orchard, and funded by a Wellcome Trust People Award scheme. The modern Bethlem site, opened in 1930, has long been overshadowed by interest in Victorian ‘Bedlam’. Yet there is much we can learn from the red-brick buildings, described by Bethlem’s chaplain E.G. O’Donoghue in the 1920s as ‘splendid mansions rising in the woods’.1

While one of these original ‘mansions’ – the Art Deco administration building – is converted into the new Museum of the Mind, we will be exploring the history of Bethlem and its place in twentieth-century mental health care. As the fabric of the building is peeled back, layer by layer, revealing architectural changes over the decades, new photography will bring the building to life, revealing the traces of those who have used it over the years. A new monthly series on the blog will provide regular updates on the project.

This will also help to expand the archive collection and displays by adding personal reflections (like those of O’Donoghue) to the archive. At present, much of this sort of material in our records comes from the Victorian hospital (now the Imperial War Museum), in the form of letters, diaries, photographs, personal papers, concert programmes and more. Yet we have very little contextual material about the present site, and the records are primarily administrative. We know from plans, for instance, that there was originally an entertainment hall behind the administration building. But we have no notes or ephemera on the plays, lectures and concerts that were undoubtedly performed.

In this project, then, we will be exploring the history of people who have used the site, whether as staff, patients, visitors or local residents. Would you be interested in being interviewed about your memories of twentieth-century Bethlem? Whether you worked here decades ago (or, indeed, still do), used to sing in the chapel as a child, or have used the services in the past, we would like to hear from you.

If you would be interested in getting involved in the Mansions in the Orchard project, please contact Sarah Chaney, Project Co-ordinator, on sarah.chaney@slam.nhs.uk. If possible, let us know in a few sentences what your connection with the hospital was.

1 Under the Dome, 1929, p. 8

 Photograph of the Bethlem Chaplain on the wooded site, 1920s

O’Donoghue on the wooded site in the late 1920s.

Hospital Snapshots 9

In 1856, when speaking about the photographs he had taken of his patients, Hugh Welch Diamond, superintendent of the Surrey County Lunatic asylum, commented that:

‘photography …. presents also a perfect and faithful record, free altogether from the painful caricaturing which so disfigures almost all the published portraits of the Insane as to render them nearly valueless either for the purposes of art or of Science.’1

Diamond’s view was certainly that photography could provide images of a different order to these earlier drawings but at the time these sketches were considered to be important and useful. Hospital Snapshots has concentrated so far on the series of photographs taken at Bethlem in the late 1850s. The next posts will examine one set of these earlier drawings, those commissioned by Alexander Morison.

Morison began his medical career in his native Edinburgh before moving to London in 1808. He became inspector of Surrey lunatic asylums in 1810 and Bethlem superintendent from 1835. In the 1830s and ’40s he commissioned artists, principally Alexander Johnstone and Charles Gow, to draw patients at a number of asylums, including Bethlem, with which he was associated. These were in part to illustrate his book The Physiognomy of Mental Diseases in which he examined five main illnesses classified in the language of the time: mania, monomania, dementia, idiocy, imbecility. These images therefore focus predominantly on the face.

The drawings are now held in the Royal College of Physicians, Edinburgh. They are more obviously working documents than the finished prints of the Hering series. Each image is drawn on a single sheet of paper, not all the same size or colour. For most it is possible to identify the artist and Morison often makes reference to artists sketching particular individuals in his diary.

The majority show a three-quarter profile or full face, displaying the head, shoulders and upper body, only occasionally anything more. The face is the most detailed part, with features, hair and complexion fully worked up. In contrast, the rest of the body is generally sketched in outline only. Though collars and hats are worked more fully, other indications of clothing are generally only sketched, where they can be seen at all. In a small number restraints, such as mittens, are visible.

There are no details of the room or surroundings and there is no record of the circumstances in which the drawing was made, whether the patient gave consent or how long the drawing took. Most of the sitters are unoccupied and there are no books or sewing to act as props.

The majority are shown twice or three times at various stages of illness and recovery. They are captioned with a date, place and set of initials alongside a diagnosis and their current state. One for example captioned ‘drawn during a lucid interval.’ The next post will examine one of the series in detail.

[1] Diamond, Portraits of the Insane, London: Burrows and Schumacher (1990)

sketch from Morison's book

Sketch from Morison’s Physiognomy of Mental Diseases (Wellcome Library, London)

UPDATE: If you want to help us to bring our photography collection into the 21st century then help us win the chance to work with acclaimed photographer, Rankin by voting here: http://bit.ly/voteBethlem.  We want to use this as a chance to show that you cannot tell if someone has a mental health issue by their appearance.

Nineteenth-Century Society: (Insanity of) Adolescence

In 1892, sixteen-year-old Harry Dearman was admitted to Bethlem with a very specific diagnosis: “Melancholia of Adolescence”. This, the teenager’s first episode of mental ill-health, had apparently commenced just three days before his admission. Harry was described as having become very reticent, refusing food and praying excessively: he had also made an attempt at suicide. The causes of the young man’s illness were thought to be both psychological and physiological: four months earlier, he had been present at the “unusually painful death scene” of a friend and fellow workman which, his relatives noted, he had frequently talked about since. In addition, however, his doctors assumed that puberty was a cause.

In the late nineteenth century, “insanity of adolescence” became a frequent feature of psychiatric texts. Primarily diagnosed by the age of the sufferer (most agreed on a more extended period than we might perhaps have expected, from the age of 14 to 25), the concept emerged from more general attention to adolescence as an important – and potentially difficult – period of development. This interest might appear obvious to a modern audience. However, prior to this period, distinctions between childhood and adulthood had often been drawn without any reference to an in-between, developmental state.

There were several reasons for this new focus within psychiatry, in addition to external cultural shifts, such as the increasing age of marriage. In particular we can see the influence of evolutionary theories of mind and the associated interest in hereditary theories of insanity. Developmental psychology thus assumed a close association between physical and mental development. As T.S. Clouston put it in Tuke’s Dictionary of Psychological Medicine:

At puberty and adolescence … the affective faculties, the social instincts, the altruistic organic cravings, the delight in poetry and romance, the sense of duty, all arise in so different and definite a form as compared with their previous existence, that we must conclude that great tracts of brain substance, which had before lain dormant, have now awakened into activity.[1]

Clouston thus correlated psychological development with physical changes in the brain. These were also thought to be associated with alterations taking place elsewhere in the body, in particular those of sexual development. Similarly, it was assumed that both physical and emotional shocks might arrest mental and physiological development. Sometimes, these might be behaviours under the patient’s control (frequent masturbation, for example, was a common charge). On other occasions, it might include pressures imposed from without, with particular reference to education, work or marriage: “disappointment in love”, for example, was a frequently cited cause for mental illness, in young men as well as women in this period.

Harry Dearman was discharged well after just over four months at Bethlem: insanity of adolescence was widely considered one of the most curable forms of mental illness, with 65% or more deemed to recover. The very existence of the diagnosis, however, points to the increased emphasis being placed on development within psychology in the late nineteenth century, and the introduction of a transitionary phase between childhood and adulthood.


[1] T.S. Clouston, “Developmental Insanities” in Daniel Hack Tuke, ed. A Dictionary of Psychological Medicine (London: J. & A. Churchill, 1892), p. 360.

Photography Feedback: Museum of the Mind

As part of our recent consultation into a number of issues relating to the Museum of the Mind, we carried out a survey on the use of real historic photographs of Bethlem patients. Those over 100 years old are in the public domain, but this does not prevent display of the images raising a number of ethical questions. In our online survey, we showed three very different images, and asked people for their thoughts on the photographs. The first one, Captain G.J., has already been blogged about in the Hospital Snapshots series. However, displayed without this information, many viewers assumed him to have been a Victorian psychiatrist rather than a patient. Portrait photographs, then, can play an important role in confronting preconceptions about mental illness, and those who experience it.

The second picture shown was more challenging to many people: indeed, while in most of our surveys the vast majority of people concluded that it is both useful and important to display historical photographs of patients, the image of Miss Smith was thought the least appropriate for display. Questions abounded about the style of the image, with the number displayed prominently on her chest the most puzzling part. Was this for identification purposes? To enable the picture to be used anonymously? Was it always worn, like a prison identification number?

This image is not, in fact, from the Bethlem Collection, although it is of a Bethlem patient. In 1881-2, Francis Galton (1822 – 1911) visited Bethlem to take a large number of patient photographs, about which we have previously blogged. Galton, a well-known scientist and cousin of Charles Darwin, was fascinated by statistical measurements of human characteristics. In 1885, he founded an Anthropometric Laboratory, at which visitors could have a variety of measurements taken, including fingerprinting and cranial measurements, paying to take the results home. His series of Bethlem portraits was another part of his data collection, which aimed to identify hereditary characteristics in asylum patients. So that he could create composites of these images (layering a number of photographs over each other), all were carefully framed so that each person’s head was in the same location and position. The numbers were presumably for identification purposes, although not everyone pictured is wearing a number, and neither are all the numbers in the same format. Nonetheless, the photographs are all very individual. Clothing and hairstyles vary considerably from person to person, as do facial expressions. Moreover, the variation in characteristics meant that Galton was not able to create composites from the images at all.

There is no record of these photographs being taken: indeed, it is mentioned nowhere in the Annual Reports or patients case books – quite unusual for scientific research carried out at Bethlem. Just under half of the hospital residents were photographed, but we don’t know how the subjects were chosen. We do, however, have records of these patients’ stays in the hospital, offering a brief snapshot of a particular period in a person’s life. Miss Smith was admitted to Bethlem on at least two occasions, both times diagnosed with acute mania. On her first admission she was 28 years old, single and living with her uncle (a potato salesman) in Peckham. She stayed for just over a year. In February 1888, Miss Smith was admitted a second time, described as noisy, incoherent and violent. Once again, she gradually became quieter, and was discharged recovered in May 1889.

What brought Miss Smith to Bethlem? It is hard to judge from the records, which offer very little detail, other than describing her incoherent speech, wild behaviour and difficulty sleeping. The photographs of this young woman, however, (a picture was also taken on her second admission, aged 35) remind us of just how little we know about her experiences beyond the medical realm: despite the fact that for most of her life she was not in an asylum, where she spent just two of thirty-five years.

The Galton photographs are part of the UCL Special Collections. You can find out more about the Galton Collection online here.

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Miss Smith photographed by Francis Galton

UCL Library Services, Special Collections