London drives some of its citizens mad. A psychiatric survey in the 1970s revealed that cases of depressive illness were three times higher in the East End than in the rest of the country. Schizophrenia was also a common condition.
As early as the fourteenth century the hospital of St. Mary of Bethlem had begun to care for those sick in mind. “Pore naked Bedlam, Tom’s a-cold.” “God Almighty bless thy five wits—Tom’s a-cold!” Their cries might also have been heard in St. Mary, Barking, “a hospital for priests and inhabitants of London, both male and female, who were inflicted with insanity.” Yet it is through Bethlem that London has always been associated with insanity. Thomas More asked if the city itself were not a great madhouse, with all its afflicted and distracted, so that Bethlem became the epitome or little world of London. In 1403 the records suggest that there were nine inmates supervised by a master, a porter and his wife, as well as a number of servants. But the number of patients steadily increased. In the Chronicles of London, dated 1450, there is a reference to “A Church of Our Lady that is named Bedlam. And in that place be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored unto their wit and health again. And some be abiding therein forever, for they be fallen so much out of themselves that is incurable to man.”
Some were allowed to leave the “madman’s pound,” as it was known, in order to wander the streets as mendicants; a tin badge on the left arm signified their status, and they were variously known as “God’s minstrels” or “anticks.” There was dread and superstition, as well as pity, surrounding them; in the streets of the city they might be regarded as tokens of the city’s madness. They were wandering spirits—sometimes abject and sometimes prophetic, sometimes melancholy and sometimes denunciatory—calling attention to the naked human condition in a city that prided itself upon its artifice and civilisation.
Early sixteenth-century maps show “Bedlame Gate” beside the highway of Bishopsgate. You opened this gate and walked into a courtyard with a number of small stone buildings; here was a church and a garden. There were thirty-one of the insane crowded into a space designed for twenty-four, where “the cryings, screechings, roarings, brawlings, shaking of chains, swearings, frettings, chafings are so many, so hideous, so great; that they are more able to drive a man that hath his wits rather out of them.” The usual treatment was the whip and the chain. In an inventory are mentioned “six chains with locks and keys belonging to them, four pairs of iron manacles, five other chains of iron, and two pairs of stocks.” Thomas More writes in that century of a man who had “ben put uppe in bedelem, and afterward by betyinge and correccyon gathered hys remembraunce to hym,” so it can be assumed that punishment or “correction” was considered efficacious. You had to be brave to be mad.
By the early seventeenth century Bedlam had become the only hospital used for the incarceration of “lunaticks.” The preponderance of them were “vagrants, apprentices and servants, with a sprinking of scholars and gentlemen. Of the fifteen vagrants, eleven were women.” There were many wandering the streets of London who might be deemed mad, and could be thrown into the compter for the night, but they generally remained at liberty. The large proportion of female vagrants among the inmates of Bedlam, approximately one in three, also throws a suggestive light on the life of the London streets.
One inmate was Lady Eleanor Davis who was confined in the winter of 1636 for proclaiming herself a prophet; she was kept in the steward’s house, rather than in the ordinary ward, but she later complained that Bedlam itself was “like hell—such were the blasphemies and the noisome scenes.” It was “the house of such restless cursing,” and she complained that the steward and his wife abused her when they were “very farre gone in drincke.” So Bedlam represented an intensification of the worst aspects of London life. That is why, in the early years of the seventeenth century, it was put on stage. In a number of dramas the madhouse became the scene of violence and intrigue, where the inmates act
Such antic and such pretty lunacies,
That spite of sorrow they will make you smile.
These lines are from Thomas Dekker’s play of 1604, The Honest Whore, which was the first to include scenes within Bedlam itself.
The fact that London contained the only madhouse in the country was in itself suggestive to dramatists. In Webster’s The Duchess of Malfi madness is associated with various urban professions, such as that of a tailor “crazed i’ the brain with the study of new fashions,” intimating once more that life in the city can render you insane. It is the most important point of contact between London and lunacy. There was another important association manifested in John Fletcher’s The Pilgrim of 1621, where the drama is concerned with the mental stability of the keepers rather than the patients. If the custodians and gaolers are mad, then so is the society that bestowed their status and responsibilities upon them.
The old madhouse was, by the middle of the seventeenth century, in such a squalid and ruinous condition that it had become a civic scandal. So in 1673 it was decided that a great modern building, situated in Moorfields, would take its place. Designed upon the model of the Tuileries Palace, and decorated with gardens and columns, it took three years to complete. Above its entry gate the sculptor, Cibber, created two bald-headed and semi-naked figures called “Raving Madness” and “Melancholy Madness”; they became one of the great sights of London, rivalling the fame of those earlier guardians of the city Gog and Magog. From this time forward Bethlem Hospital acquired its true renown; visitors, foreign travellers and writers flocked to its apartments in order to see the mad confined within them. It was of great importance to the city, and to the civic authorities, that lunacy should be seen to be managed and restrained. It was part of the great movement of “reason” after the Great Fire and the plague, when the city itself had become the scene of madness and unreason on an enormous scale. Daniel Defoe had narrated the events of 1665 when so many citizens were “raving and distracted, and oftentime laying violent hands upon themselves, throwing themselves out of their windows, shooting themselves, mothers murdering their own children in their lunacy—some dying of mere grief as a passion, and some of mere fright and surprise without any infection at all, others frightened into despair and melancholy madness.” Londoners had a propensity for mania; perhaps that was the condition for their very existence in the city.
Yet, as if to point the moral that lunacy is undignified and absurd, the inmates were on display like so many wild beasts in a zoo; they were ravening creatures that had to be manacled or tied. There were two galleries, one above the other; on each floor a corridor ran along a line of cells, with an iron gate in the middle to divide the males from females. Outside it seemed to be a palace; inside, it closely resembled a prison. The price of admission was a penny and it has been reported that the “distempered fancies of the miserable patients most unaccountably provoked mirth and loud laughter in the unthinking auditors; and the many hideous roarings, and wild motions of others, seemed equally entertaining to them. Nay so shamefully inhuman were some … as to provoke the patients into rage to make them sport.” This “familiar letter” from Samuel Richardson provides a mid-eighteenth century picture of desolation which is fully documented by other sources.
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.”
In more recent years, too, the mentally ill have been released on medication “into the community.” On the streets of London it is not uncommon to see passers-by talking rapidly to themselves and sometimes gesticulating wildly. On most main thoroughfares you will see a lone figure huddled in a posture of despair, or staring vacantly. Occasionally a stranger will shout at, or offer violence to, others. There was once a famous saying of London life,
Go thy way! Let me go mine
to which may be added,
I to rage, and you to dine.