A Touch of Bedlam



The Oxford English Dictionary defines the word Bedlam as “a scene of uproar and confusion.” Bedlam was also one of the alternative names of Bethlem Royal Hospital (also known as St. Mary Bethlehem and Bethlehem Hospital). Located in London, this medical institution is Europe’s oldest and first center to specialize in mental illnesses. It is also infamous for being for one of the most notorious asylums in history.

Bethlem Royal Hospital was founded in 1247 at Bishopsgate. It was built as a means to collect alms to support the Crusaders and to also connect England with the Holy Land. Eventually the center also became a place where the poor and sick could be cared for. Throughout the 13th and 14th Century, Bethlem was still being used to collect alms, but it’s links to the church were getting even more strained. In the 1370’s Edward III seized Bethlem for the crown’s control, as it was not under the control of an English religious house, and from this point Bethlem became more secular.

It is hard to know for certain when Bethlem became an asylum. Although from 1330 it was referred to as a hospital, “hospital” in this time often meant a place where travelers could stay – similar to a hostel or where the poor could be cared for. However, the first record of mentally ill patients was in 1403, of 6 men who were “mente capti” – a Latin term suggesting insanity. It seems likely that Bethlem gradually moved from a general hospital to a specialist center by 1460.

In 1546 the Lord Mayor of London asked Henry VIII to grant the control of Bethlem to the city. The Mayor was successful, so whilst the crown still held the Hospital, the everyday administration now fell to the city officials. This co-operation between the city and monarchy continued well into the 20th Century, until 1948 when Bethlem came under control of the National Health Service.

However, the title of Master at Bethlem was one of little work, and often one would be appointed due to favoritism by the crown or the aldermen. As such, they cared little for the patients. A report conducted in the late 16th Century found that Bethlem was “…not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fitt for anye man to come into the sayd howse”. In order to raise funds to improve conditions at Bethlem, the Governors decided to open the asylum for public viewing, allowing people to gawk at the patients.

Although Bethlem had been known as Bedlam in the 14th Century, by the 17th Century it had began to be used as a term to describe madness. This was because many popular plays of the era had used Bethlem as a setting. In 1619, King James I had been able to secure the appointment of Helkiah Crooke as keeper-physician. Crooke had argued that as a medical man he was more than qualified to be in this position. The fact is that he certainly was not. During Crooke’s tenure; he hardly visited Bethlem and embezzled funds for his personal use, withheld food from the patients unless they provided money, patients roamed free in Bethlem and the local area, and patents would often be found sleeping in their own waste.


Thankfully, Crooke was dismissed due to his negligence in 1633. This also marked a change in administration for Bethlem. From 1634, Bethlem was ran equally by a non resident physician, a visiting surgeon and an apothecary. Additionally, to prevent what had happened with Crooke, the positions were salaried. But by 1674, Bethlem was too small and old to deal with the increasing amount of patients. Therefore, a new, much larger building, with an outdoor space for the patients to exercise in was finally completed in 1676 at Moorfields. The new building had another purpose though, as the funds for Bethlem often relied on public charity, this new building was a large self-advertisement. So, after the new building, many more people began to visit Bethlem.

Unrestricted public access ended in 1770. However, with the staff now less open to public scrutiny, patient abuses occurred. Furthermore, inadequate funds exacerbated by the Revolutionary Wars now plagued Bethlem. The hospital was in such disrepair that it was cheaper to rebuild Bethlem at a new site instead of fixing the current building. In 1815 the new building was completed at Southwark, however several buildings had to be added later due to overcrowding.

But still Bethlem was embroiled in scandal due to the treatment of the patients, and furthermore, public opinion on the mentally ill was changing. A Quaker known as Edward Wakefield was one of the most important people in publicising in what was happening in Bethlem and in other asylums across the country. In Bethlem, he found that patients were grouped together despite varying conditions, were chained and naked, and that the staff were thuggish. His reporting led to a campaign for reform for the mentally ill and the establishment of a committee concerning these issues. Soon after in 1816, the principal physician resigned due to scandal regarding his “wanting in humanity” towards the patients.

Bethlem moved one final time in 1930, to the outer suburb of Bromley where it still stands today. Currently, it houses the National Psychosis Unit and cares for approximately 350 patients. But when Bethlem sought to celebrate its 750th Anniversary in 1997, the patient’s perspective was not going to be included. In response, members of the Psychiatric Survivors Movement protested as they saw nothing to celebrate in Bethlem nor in the current practices of mental health professionals.

After researching and writing this article, I can clearly see their point.


ABOUT THE AUTHOR: Scarlett Grant will graduate university this year. She is half scared and excited to be entering “the real world.” She is an amateur history buff, and interested in music, film and writing.

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