London: The Biography

One other commentator, on witnessing these scenes, remarked “that the maddest people in this kingdom are not in but out of Bedlam.” Here was the most curious thing: the building in Moorfields provoked irrational behaviour in its visitors as well as in its inmates, the whole scene of “wild motions” (which can be deemed to be sexual) and “hideous roarings” creating an unimaginable confusion of types and roles. Prostitutes used to linger in the galleries, looking for custom, on the principle that lustfulness might be excited by the antics of the mad. It was suggested, only half seriously, that another asylum be built to house those who came to mock and make sport of the insane. So it might seem that the contagion of madness spread from Moorfields across the whole city.

Thus, in the literature of the period, “Bedlam” becomes a potent metaphor for all the evils of London. In Pope’s verses it casts its shadow over Grub Street, where poverty and lack of accomplishment have driven many mad. Traherne wrote that

The World’s one Bedlam, or a greater Cave

Of Mad-men, that do alwaies rave.

John Locke compared temporary madness to being lost in the streets of a strange city, a suggestive analogy which was taken up by many observers of London. In Smollett’s Humphry Clinker, for example, Matt Bramble remarks of Londoners that “All is tumult and hurry; one would imagine that they were impelled by some disorder of the brain, that will not suffer them to be at rest … How can I help supposing they are actually possessed by a spirit, more absurd and pernicious than anything we meet within the precincts of Bedlam?” So the building at Moorfields rears over a city which is infected with the same disorder. The citizens of London live in a state of unnatural energy and uproar; they live in foul houses with no light or air; they are driven by the whip of business and money-making; they are surrounded by all the images of lust and violence. They are living in Bedlam.

By the end of the eighteenth century Bethlem Hospital had acquired its own patina of decay and desolation. In 1799 a commission described it as “dreary, low and melancholy” as if the material fabric had been infected by the melancholy madness of its inhabitants. The neighbourhood was itself suffused with dreariness; the hospital was “surrounded by squalid houses” as well as a number of shops dealing in old furniture. So in 1807 it was agreed that the institution should move across the river to Southwark. The third Bedlam in London’s history rose within appropriate surroundings, since Southwark had always been the nursery of prisons and other institutions.

The new building was as grand as its predecessor, with a portico decorated with Ionic columns and surmounted by a great dome. Yet the conditions of the interior were as sparse as before, as if once again the whole purpose of the building was a theatrical display designed to depict the triumph over lunacy in London. The two sculpted giants of madness, known popularly as “the brainless brothers,” were kept in the vestibule.

Methods of treatment remained severe, and were largely dependent on mechanical restraint; one patient lay in chains for fourteen years. It was not until the mid-nineteenth century that a more “enlightened” policy was developed; after two inquiries had been severely critical of the hospital regime, a “moral medical” treatment was instituted with the patients being given jobs or occupations as well as medical therapy with drugs such as chloral and digitalis.

It was a world within a world. Its water came from an artesian well within the grounds, so that the patients remained free of the cholera and dysentery which raged around them. And there was a monthly ball, where the patients danced with one another; many observers commented on this moving and somewhat bizarre occasion. Yet still the persistent question about madness remained. Charles Dickens walked past the hospital one night, and was moved to reflect: “Are not all of us outside of this hospital, who dream, more or less in the condition of those inside it every night of our lives?”

The rate of insanity in London had tripled by the middle of the nineteenth century, and other institutions for the mentally ill were established; those of Hanwell and Colney Hatch were perhaps the best known. Bethlem moved to the country, near Beckenham, in 1930, but by that time the capital was well stocked with asylums. These in turn have become known as mental health units or “trusts,” where patients are “service users.”