Posts Tagged 'patient experience'

Getting into Georgian Bethlem 1

The restrictions on admission to and discharge from Bethlem Hospital in the eighteenth century often come as a surprise to first-time researchers. (So, incidentally, does the language in which these restrictions were expressed). ‘Mopes, Persons afflicted with the Palsy, or subject to Convulsive or Epileptic Fits, or such as are become weak through Age or long Illness are not proper Objects of this Charity,’ according to the Hospital’s printed admission regulations.

In other words, the Georgian Hospital wished to focus its therapeutic efforts on those patients it regarded as most amenable to recovery, and commonly discharged uncured those who had not recovered within a year of admission. For example, 60% of patients admitted between 1694 and 1718 stayed no longer than twelve months, and a further 16% stayed no longer than twenty-four.

To ameliorate the hardship sometimes caused by discharging patients uncured, the Hospital opened a new ward in the 1720s in which ‘incurable’ patients could remain. Those still unwell twelve months after admission were assessed as to whether they were ‘fit’ and ‘proper Objects’ for this ‘Charity’. Space in this ward was at a premium, however. The majority of uncured patients were judged ‘unfit’ upon discharge, and even the patients considered ‘fit Objects’ for transfer had to wait until a vacancy became available on the ‘incurable’ ward.

But here’s the thing: patients could not be admitted to the ‘incurable’ department directly; they arrived there only by internal transfer. So those considered incurable at the outset were not admitted at all. Here we see Georgian Bethlem striving hard to avoid becoming in reality what it was in uninformed popular imagination: a warehouse of human misery. Its primary strategy was to enforce its published strictures on entry. Admission petitions ‘will be laid before the Committee… who…will make an Order as soon as there is a Vacancy, for the Patient to be brought to be Viewed as Examined by them and the Physician, and to be then admitted, if [and only if] a proper Object’.

The published histories of the Hospital often turn attention to its famous (or infamous) patients. But in blog posts to follow, the Archivist will describe attempts to find places in Bethlem’s ‘incurable’ ward for two ‘ordinary’ people of the eighteenth century…attempts which, as we will see, soon ran into difficulty.

'New Bedlam in Moorfields' in newbed

Georgian Bethlem, in Moorfields


Nineteenth Century Society: Women, Madness and Marriage 1

This short series looks at the very different experiences of several of Victorian Bethlem’s female patients regarding marriage. The diversity of these reminds us of how problematic it can be to make general assumptions about social expectations in the nineteenth century, despite the fact that some cases do indicate elements of the stereotypes commonly indicated by many feminist histories.

What might be of particular interest in an era in which online dating has received regular attention – both positive and negative – is those references found in the Bethlem casebooks to matrimonial agencies. For single women well past the usual marrying age, such as Mary Ann Swann, who was admitted to Bethlem in July 1895 as a voluntary boarder, social expectations could be difficult to deal with. Young people were expected to suffer from insanity following “love disappointments,” yet in fifty-year-old Swann’s case, her attitudes to marriage were seen as evidence of her mental illness. Mary Ann held the delusion “that she is persecuted by her sisters in order that they may keep her money … She is also erotic & desires to marry some man who will protect her from her sisters & brothers.” While her desire to marry in order to escape her perceived persecution could be regarded as quite a rational response to something she felt was very real, Mary Ann’s persistent desire to marry was instead regarded in Bethlem as a further delusion, related to her “erotic” nature: inappropriate behaviour in someone regarded as a confirmed spinster.

What was most problematic was Swann’s use of matrimonial agencies to effect her object: the Commissioners in Lunacy clearly regarded this as a dubious means of finding a suitor. After she was discharged well, in September 1895, Commissioner Mr Frene paid a visit to the Hospital, presumably instigated by the patient’s relatives, “to enquire how it was that this patient was at large as she was doing most extraordinary things & was shortly to be married to a man whom she had got to know through the Matrimonial News.” The Bethlem medical officers promptly arranged for Swann’s re-certification: presumably suspicion of such dating agencies was widespread. Mary Ann herself regarded her re-admission as a conspiracy on the part of her relatives, claiming that there was nothing extraordinary in her conduct. Yet, as Bethlem superintendent George Savage pointed out in his published writings, in the frequent absence of visible physical signs and symptoms the presence or absence of insanity had often to be determined by behaviour, regardless of the patient’s protestations. In the event, Mary Swann was discharged well after three months as a Bethlem patient.

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

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)

Peter Rowbotham Artwork

“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

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…”

female ward

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: (no booking necessary for individual visitors to the museum or gallery).


In the Frame for July 2010

The Archivist writes:

My painting of the month is On the Ward, a cartoon vignette of a Maudsley Hospital ward, drawn – we think in the 1940s – by someone known only as ‘Nelson’. The scene depicted is one of pathos and black humour in turns, as the bedridden patients each face private dramas of varying degrees of implausibility.

Above the mantelpiece, where in a 1940s hospital you might expect to find a portrait of the King, hangs a caricature of what appears to be the Maudsley’s medical superintendent. A man is sitting up in bed to the right of the fireplace, reading a book titled Blood and Gore. He is sweating profusely, his face is contorted and his head is pounding. To his right, another man sleeps, but not soundly: in an age of rationing and austerity, he dreams of pork chops. Others dream of ‘Battle of Britain’ dogfights and of saws cutting through wood. Those awake are variously pictured playing a panoply of musical instruments, being prodded by a doctor with a bag of nasty-looking tools and team of inquisitive onlookers beside him, or selling prayer shawls to bickering nurses.

The scene is deliberately far-fetched, and yet it sounds an authentic note of frustration at the want of privacy and purposeful activity on a psychiatric ward. Thomas Hennell, a Maudsley patient of the 1930s and another artist, complained in his autobiography that “we were kept in bed, and to some extent under drugs and suggestion…the most comfortable state was one of half-dozing; in this condition the mind seemed to get physical relief; but the conscious waste of time was very troublesome, and, on the other hand, reading was burdensome, and quickly produced a confused and turbid state” (The Witnesses, p. 167). On the Ward seems to have been ‘Nelson’s’ mock celebration of this enervating state of affairs.