The Lost Hospitals of London: The Bethlem Hospital

Whilst I’m delighted to be contributing to Gresham College’s series of lectures on the Lost Hospitals of London, I have to tell you that in commuting up from the Hospital this morning I have left behind hundreds of staff and patients who would be rather perplexed to learn that Bethlem Hospital is ‘lost’. Like two of the other five Royal Hospitals of London – Bridewell and Christ’s – it is no longer located in or near the Square Mile, but unless one believes that one is never more lost than when on the streets of deepest south London, Bethlem is not ‘lost’. It remains to this day a working psychiatric hospital, part of a NHS Foundation Trust devoted to mental healthcare, having first moved south of the Thames in 1815 (into a building which now houses the Imperial War Museum), then again in 1930 to the Beckenham / Croydon borders, in search of the kind of leafy, open environment which was considered to be most conducive to patients’ recovery.

I do not intend to treat these later chapters in the Hospital’s history in any detail today, though I am willing to field any questions there may be about them later – indeed I will have a go at answering any questions at all later. Instead, I have chosen to focus on Bethlem’s practice of allowing public visiting of its wards with only the loosest of restrictions, but gradually tightening restrictions nevertheless, until 1770. This self-imposed limitation of focus and of date has the advantage of firmly anchoring Bethlem within the City. From its foundation in 1247 until 1676, Bethlem was located in Bishopsgate. No trace of it remains today other than a blue plaque on a wall adjacent to Liverpool Street Station.

Then from 1676 to 1815 the Hospital was located on the south side of what is today Finsbury Circus. Again, no physical trace of it survives except for a blue plaque, this time on the side of a pizza restaurant. By the early nineteenth century the building was clearly failing, the Hospital Surveyor having declared original construction to have taken place with ‘inconsiderate zeal, and more haste than evident wisdom’, rendering its present state ‘incurable’. It was demolished, and all its fittings, fabric and masonry – save for two particular items – auctioned off in 1815. The two items saved were Cauis Gabriel Cibber’s famous larger than life statues of Raving and Melancholy Madness, which reclined atop Bethlem’s entrance gates and had become London landmarks. They are on permanent display in the small Archives & Museum maintained at today’s Bethlem Hospital in Beckenham, where I am the Archivist.

If anything could be accurately described as lost, it is precisely the dominating structure of Bethlem at Moorfields. Yet the Hospital, its iconic statues and supremely the memory of its role as a ‘visitor attraction’ of sorts have maintained a constant profile in the mental landscape of London. For three hundred years the Hospital and its inhabitants have provided a set of ready-to-hand metaphors for – variously – the hare-brained excesses, the excruciating poverty, the naked irrationality, the greed and rapaciousness, the hedonism and hypocrisy, and the sadistic and voyeuristic tendencies of contemporary culture. And these metaphors have precisely not been lost. To give you an initial sense of this, let me cite just two modest examples, one eighteenth-century, the other twenty-first. The first is a passage from anonymous work of potboiling fiction entitled A Description of Bedlam published in 1722 which purports to be an account of what someone saw on a guided tour through the wards of the Hospital. It reads:

“Then turning my Eyes to the next Cell, my Guide said, As yet there is no-body in this Room; but we daily expect a Man who lately bore a very considerable Figure in the South-Sea Company, being no less than one of the late Wicked Directors. This Man, said he, like the rest of his Fraternity, set up at an extravagant Rate, during the late Time of Distraction, when all the World became a Bedlam, and London and Westminster made but One great Mad-House.”

Here is reflected the darkening public mood towards financiers precipitated by the bursting of the South Sea Bubble. The author’s London is ‘one great mad-house’, his or her country having just emerged from a ‘time of distraction’. Whether this has any contemporary resonance I must leave to your judgement. My point here is simply that though this passage clearly trades on widely shared public experiences of visiting Bethlem, it clearly constitutes social commentary rather than factual reportage. The rich storehouse of metaphor associated with the Hospital continues in use today, as my second example shows. Interviewed for the Guardian newspaper in 2009, the TV presenter Michael Parkinson was reported to have said “I object to the exploitation of the underclass in shows like Big Brother. It is the modern version of Bedlam, here you pay to see the poor benighted people making asses of themselves.”

Whereas unrestrained greed and wild speculation were the target of the first example, prurience and Schadenfreude are the target of the second; but in these cases and in many others the historical memory of Bethlem frames the discourse, especially as it feeds the metaphor of Bedlam. Noticing this, the historian Keir Waddington has recently commented:

“Apparently much is known about the Bethlem Royal Hospital and its alter-ego, Bedlam…It was one of the sights of London, allegedly admitting an estimated 96,000 visitors a year until 1770. It is common knowledge that the staff were fraudulent and that the Governors were unaware of what was happening, incapable as they were of running the Hospital…Bethlem did not even pretend to care for its patients. These facts have been repeated so often that a historical image has been created of an institution that has come to symbolise all that was mad and bad about the management of the insane.”

I think you can sense that there is a lot to unpack and tease out here. I would not for a moment want to deny that the there is no truth whatsoever informing the old chestnuts mentioned by Waddington, but the relationship between the memory and the metaphor turns out to be, as one might expect, rather more nuanced than at first sight. The way I propose to proceed is as follows: first we will trace the measures taken by Bethlem’s Governors in respect of public visiting, to give us a structure for understanding what happened when, then we will scour first-person narratives of visits to the hospital to discover what motivated people to visit Bethlem, and what reflections were prompted by their visit, to discover whether or not, in their terms, the Hospital was indeed worth a visit. I should say at the outset that, while the minute books of the Court of Governors are held within the Bethlem archives, I have not read every page of them, and that I am grateful to Dr Jonathan Andrews of Newcastle University for having shared with me the fruits of his work on these books in identifying passages from them that have to do with public visiting.

The earliest direct mention of public visiting in the minute books of the hospital’s Court of Governors, then, is dated 29 March 1637, when a prohibition is placed on the Hospital’s employees soliciting or receiving money for their own use from visitors to the Hospital. “They are charged to bring the Porter whatsoever is given in the house or at the doore for the benefit of the poore Lunatiques And no servant is to begge or require anything of any person coming to Bethlem…to their owne uses but they are to rest contented with their wages and whatsoever is given there and received by any servant is to be delivered forthwith to the Porter and by him to be brought to Accompt.” This is the first of a string of measures designed to ensure that that monies given as charitable donations toward the work of the hospital ended up with the hospital and not in the pockets of individual members of staff. The fact that there were a string of measures is suggestive of an environment of chaos, corruption and poverty.

Even more interesting than the particular content of this minute is the fact that it is the earliest known mention of public visiting within the Bethlem Governors’ meeting minutes. Here the Governors seek to regulate the practice of almsgiving within the context of visiting, but nowhere in their minutes is any record of an original decision to permit it in the first place.

This omission, and the relatively late date of this first minute book entry, 1637, has encouraged one historian to question how far back the practice of visiting Bethlem patients actually stretched. While admitting that “many people went to Bethlem throughout its long history…for many reasons – to bring in distracted persons and take them home when recovered, to visit and provision friends and relatives there, to leave charitable donations, to examine the property or the inhabitants for the City of London’s Court of Aldermen – and perhaps to be morally instructed”, Carol Ann Neely does not believe that Bethlem functioned as “a spectacle or tourist attraction” before 1632.

(1632, by the way, is the date of the publication of the findings of a Privy Council investigation into Bethlem’s financial affairs, which included the detail that money was “given at the hospital door by persons that come to see the house”, as well as the date of publication of an account of conditions at Bethlem by the clergyman Donald Lupton, which I will refer to later in this lecture.)

In particular, Neely disputes that a 1609 reference to a group which included children paying 10 shillings for going to London to see “the show of Bethlehem” along with the Lions and the fireworks at the Artillery Gardens has anything at all to Bethlem Hospital; nor has it occurred to her that Thomas More’s 1522 remark that “thou shalt in Bedleem see one laugh at the knocking of his own head against a post”, in support of an argument that not everything we find pleasurable is actually good for us, carries the implication that some of his readers could and actually did visit the Hospital to see its patients. In particular, she thinks it implausible that “children as young as eight, eleven and twelve” would have been taken on a visit to Bethlem.

I will say a little about children visiting the Hospital a little later. However the natural reading of these references supports the mainstream view, it seems to me, that the practice of indiscriminate visiting at Bethlem stretches back into at least the sixteenth century and possibly earlier. The fact that there is no direct mention of the practice in the minutes of the Court of Governors until 1637 reflects the fact that they did not govern Bethlem’s affairs at all until the 1570s, and then were content to govern at arm’s length, leaving the minutiae of its day-to-day administration in the hands of its salaried officers until well into the seventeenth century. In understanding this, we are not helped by our modern perspective. We consider unrestricted hospital visiting to be a highly unusual practice, certainly one unfit for children, and one which would in any event require extensive justification. In medieval and early modern times, the assumption was likely to have been just the opposite: what needed accounting for might not have been the practice of permitting visiting, which could have been regarded as a given from time immemorial, but any restriction on this right. The minutes of Bethlem’s Court of Governors give just such an accounting, starting in 1637 with restrictions on how donations are to be given as we have seen.

Let me briefly mention a few other regulations made: in 1677, shortly after the Hospital’s original relocation from Bishopsgate to Moorfields, the Governors ordered “…that one of the Servants in the said hospital doe ring the Bell there every Evening att seaven of the Clocke from o’ Lady day to Michaelmas yearely. And att 9 of the Clocke every evening from Michaelmas to o’ Lady day yearely. And that such persons as shall then be in the said hospital after the ringing of the said Bell to see the Lunatikes in the said hospitall be delivered to departe out of the said hospitall. And that noe person be permitted to come into the said hospitall to see any Lunatikes there after the Ringing of the said Bell in any Evening except they be persons of Quality or Governors of the said hospitall or such persons as shall come with any Governor of the same hospitall…”

In other words, hospital governors and ‘persons of quality’ can gain admission after closing time, but (by implication) there is no requirement for visitors before that time to be ‘persons of quality’, a phrase we must understand in terms of social class and connection rather than in terms of character. Then in 1681 prohibition on male access to the women’s wards was enacted except during daylight hours and then only in the company of female members of staff, and in 1699 a ban was introduced on the admission of anyone thought by the staff “to be a Lewd or disorderly Liver. Nor any Young boys or Girls that they think are Apprentices and have noe other Buisynesse in the said hospital than to spend their time Idly there”,

Of course the potential abuses to which the practice of indiscriminate visiting was open are reflected in the character of these regulations and others which were made from time to time in the seventeenth and eighteenth centuries. There was no law against visitors bringing their pet crocodiles with them, but you can be sure that there would have been one soon enough if people started to do it. The Hospital may never have intended to mount what Carol Neely calls “a spectacle or tourist attraction”, but its open doors effectively constituted an invitation to the general public to treat it as such if they so desired. Accordingly, in the knowledge “that Great Riots & Disorders had been Committed in the Hospital during the Holidays at Christmas Easter & Whitsuntide”, immediately previous, in 1764 the Hospital’s Governors ordered that the Steward “Do provide four Constables and also four Stout Fellows as Assistants in each Gallery in Order to Suppress any Riots or Disorders that might happen on Monday & Tuesday in Next Week.” Two years later they decreed “that for the future the Doors of Bethlem Hospital be kept Locked and no stranger Permitted to come in upon the Mondays Tuesdays and Wednesdays next after Easter Sunday, and Whitsunday and the three succeeding Days next after Christmas day Yearly.”

And finally in 1770, “having taken into Consideration the present Method of Admitting Persons into the Hospital to Visit and View the Patients”, and observing that “great Irregularities are daily Committed, the Patients disturbed and often Robbed of their Provisions and Cloaths by the Admission of improper Persons into the Hospital” the Governors ordered that “for the future the Gates of the Hospital should be kept constantly Shut And that no person or persons whatsoever,except a Governor, or in Company with a Governor and the Officers and Servants of the Hospital be Permitted to enter the same, unless he she or they produce to the Porter of said Hospital a Ticket Signed by one of the Governors thereof the said Tickets to be provided by and delivered out under the Direction of the Treasurer & Committee of said Hospital….”

Although it took a couple of decades to iron out certain anomalies in the ticketing system proposed here, this decision of 1770 effectively ended the hospital’s use of visiting as a revenue-raising strategy and for all intents and purposes took Bethlem off the tourist trail, if we can call it that. Although I have been critical of Carol Neely, I am grateful to her for raising the question of what it can have meant to be on the tourist trail in seventeenth and eighteenth century London. Her list of possible motives for visiting other than voyeuristic amusement lends depth and perspective to what would otherwise be a cartoon understanding of why people came to the Hospital: remember “to bring in distracted persons and take them home when recovered, to visit and provision friends and relatives there, to leave charitable donations, to examine the property or the inhabitants for the City of London’s Court of Aldermen – and perhaps to be morally instructed”. We will find all this in the accounts people wrote of visiting Bethlem. We will find “spectacle and tourist attraction” there as well – indeed does not Thomas More’s description of the head-banging lunatic function as spectacle and moral lesson simultaneously?

Yet before we launch into a discussion of these accounts it is worth getting a sense of the scale of the phenomenon. This is something that has been the subject of wild speculation based on calculations derived from the fact that annual income from visitor donations in the mid-eighteenth century occasionally reached £400 and the widespread assumption that each visitor paid a penny to enter. This results in annual visitor numbers of as many as 96,000. You may remember this figure from the Keir Waddington quotation I used earlier. Not bad for a hospital in a city with one-tenth of the population it has now – in fact, incredible for a hospital in a city of that size.

And I really do mean incredible, because that assumption about each visitor paying one penny turns out to be without foundation, as Patricia Allderidge, my predecessor as Bethlem Archivist, first went into print to point out. A payment or donation was certainly required by the hospital, and a penny or two was conceivably the least sum that could be respectably offered by the poorest visitor, but the amount was not fixed and it is likely that many donations were in excess of this sum. We may recall that 10 shillings were given by the 1609 “show of Bethlehem” visitors; and the Prince of Wales gave 5 guineas in 1735. If the average donation was 1 shilling, Bethlem might have had 8000 visitors in its bumper years. But the fact is that no-one can know what average donations or visitor numbers were. From the Hospital’s accounts we can detect a seasonality to visitor donations (and consequently, all else being equal, to visitor numbers), and we know that there was a high concentration of visitors, and sometimes attendant problems with crowd control, on religious holidays. An account published in the London newspaper The World in 1753, to which we shall later return, speaks of at least one hundred people visiting at one time in one of the Hospital’s most busy periods, Easter Week – a number which is consistent with an annual visitor total in four figures rather than in five or in six. If a contemporary analogy helps you to get a handle on the numbers, I suggest we stop thinking in terms of the Museum of London’s annual visitor figures and starting thinking about those for the Museum of Garden History. Seventeenth and eighteenth century Bethlem wanted to attract visitors and generate revenue just like any twenty-first century tourist attraction, but perhaps it did not do so on the scale that is usually imagined. The architectural historian Christine Stevenson has speculated that the second palatial hospital at Moorfields was designed to attract the interest of wealthy visitors; and more generally to advertise the bounty and benevolence of the great and good of the city of London toward the poor insane.

She does so not only in her published writings but also in a film clip included in an online resource within Bethlem Archives & Museum’s website, which I commend to your attention at:

I have made extensive use of the research that lay behind this resource in preparing this presentation, and the research was a joint effort of the Archives & Museum, Dr Stevenson and Dr Andrews whom I mentioned earlier.

Now we’ll start our survey of accounts of visiting Bethlem with those who went simply to be amused, and betrayed no trace of shame at what they were doing. In 1710 the travelling German scholar Von Uffenbach arrived at Bethlem and asked to see a patient who, he had been told, “crowed all day long like a cock”. The staff knew “nothing about him” but recommended he see another patient instead, whom they considered “the most foolish and ludicrous of all...because he imagined that he was a Captain and wore a wooden sword at his side and had severall cock's feathers stuck into his hat. He wanted to command the others and did all kinds of tomfoolery.” Von Uffenbach “threw a shilling or two down to him, with which he appeared highly delighted”, saw other male patients with milder conditions, “not mad but only deprived of their wits or simple” and female patients he described as “utterly repulsive”. All in all, a wonderful day out for the scholar.

Three accounts written at around the same time detail visits made in the company of children or young people – exactly the type of visit which Carol Neely found hard to credit in the 1609 example we looked at earlier.

The following was written under the nom de plume of Isaac Bickerstaffe in 1709: “I…am particularly observant of the Temper and Inclinations of Childhood and Youth, that we may not give Vice and Folly Supplies from the growing Generation. It is hardly to be imagin’d how useful this Study is, and what great Evils or Benefits arise from putting us in our tender Years to what we are fit or unfit: Therefore on Tuesday last (with a Design to sound their Inclinations) I took Three Lads, who are under my Guardianship, a rambling in a hackney-coach, to show ‘em the Town, as the Lions, the Tombs, Bedlam, and the other Places which are Entertainments to raw Minds, because they strike forcibly on the Fancy. The Boys are Brothers, one of Sixteen, the other of Fourteen, the other of Twelve.”

The diarist Samuel Pepys and the satirist Jonathan Swift felt no need of pseudonyms when describing visits made to Bethlem, Pepys diarising that the “young people” of his household” went to see Bedlam” in February 1669, Swift describing in 1710 a party which included women and children that visited first the Tower of London where they “saw all the sights, lions etc.” then went “to Bedlam; then dined at the Chop-house behind the Exchange; then to Gresham College... and concluded the night at the Puppet-Show”. These extracts put me in mind of The Rough Guide to Britain’s recommendation concerning the London Dungeon: it is best enjoyed by “young teenagers and the credulous”.

In 1749 a young man named William Hutton walked to London from Nottingham to buy the tools he needed to work as a bookbinder. While staying in the capital, as he later wrote “‘I wished to see a number of curiosities, but my shallow pocket forbade. One penny, to see Bedlam, was all I could spare. Here I met with a variety of curious anecdotes; for I found conversation with a multitude of characters…I never was out of the way of entertainment.”

Then in a 1760 equivalent to the Rough Guide to Britain, Thomas Brown recommends a visit to Bethlem among other London amusements such as the Playhouse, Westminster Hall, Gaming Houses and Coffee Houses: “Bedlam is a pleasant place, that it is, and abounds with amusements; the first of which is the building so lately a fabrick for persons wholly insensible of the beauty and use of it: the outside is a perfect mockery to the inside, and admits of two amusing queries, whether the persons that ordered the building of it, or those that inhabit it, were the maddest? … But what need I wonder at that, since the whole is but one entire amusement? Some were preaching, and others in full cry a hunting. Some were praying, others cursing and swearing. Some were dancing others groaning. Some singing, others crying, and all in perfect confusion. A sad representation of the greater chimerical world!”

These visitors seem to have considered Bethlem to be worth a visit in an uncomplicated, morally complacent kind of way. There are not many accounts which demonstrate a greater degree of self-awareness. In 1784, the poet William Cowper wrote to his clerical friend John Newton: “In the days when Bedlam was open to the cruel curiosity of Holiday ramblers, I have been a visitor there. Though a boy, I was not altogether insensible of the misery of the poor captives, nor destitute of feeling for them. But the Madness of some of them had such a humorous air, and displayed itself in so many whimsical freaks, that it was impossible not to be entertained, at the same time that I was angry with myself for being so.”

Cowper’s lines are interesting because of his admission of the moral conflict within himself occasioned by a visit to Bethlem – perhaps this is no more than what we would expect from a poet of the English evangelical revival. But it is surprising that it was not more widely shared. Eighteenth century essayists do of course line up to deplore the practice of visiting in general and the behaviour of visitors in particular. Yet the objects of their disapproval are, more precisely, all visitors except for themselves and like-minded ‘persons of quality’, whose visits are driven by higher motivations than voyeurism. A good example is the 1753 correspondent to the The World newspaper I mentioned earlier, who – perhaps tellingly – preferred to remain anonymous: “Sir, to gratify the curiosity of a country friend, I accompanied him a few weeks ago to Bedlam; a place which I should not have otherwise have visited, as the distress of my fellow-creatures affect me too much to incline me to be a spectator of them. I was extremely moved at the variety of wretches, who appeared either sullen or outrageous, melancholy or cheerful, according to their different dispositions; and who seemed to retain, though inconsistently, the same passions and affections, as when in possession of their reason”.

You get the picture: first the letter-writer claims that it wasn’t their idea to go in the first place, as they would be the last person to gain pleasure from ogling the crazy people, next they start on a description of the people he saw, of which I will spare you the details, before going on to make what they evidently considered to be a critical distinction between types of visitor:

“To those who have feeling minds, there is nothing so affecting as sights as these; not can a better lesson be taught us in any part of the globe than in this school of misery. Here we may see the mighty reasoners of the earth, below even the insects that crawl upon it; and from so humbling a sight we may learn to moderate our pride, and to keep those passions within bounds, which if too much indulged, would drive reason from her seat, and level us with the wretches of this unhappy mansion.”

This, the writer says, is what is likely to make Bethlem Hospital worth a visit for ‘persons of quality’. Yet the letter goes on: “But I am sorry to say it, curiosity and wantonness, more than a desire for instruction, carry the majority of spectators to this dismal place…I found a hundred people at least, who…were suffered unattended to run rioting up and down the wards, making sport and diversion of the miserable inhabitants; a cruelty which one would hardly think human nature capable of! Surely if the utmost misery of mankind is to be made a sight of for gain, those who are the governors of this hospital should take care that proper persons are appointed to attend the spectators; and not suffer indecencies to be committed, which would shock the humanity of the savage Indians. I saw some of the poor wretches provoked by the insults of this holiday mob into furies of rage; and I saw the poorer wretches, the spectators, in a loud laugh of triumph at the ravings they had occasioned. In a country where Christianity is, at least, professed, it is strange that humanity should, in this instance, so totally have abandoned us.”

So here’s the proposed distinction: between visitors who like the letter-writer have “feeling minds” and are capable of moral education; and those who come only to mock, who are even more wretched than Bethlem’s patients, not mention the “savage Indians”. It is a distinction freighted with overtones of class, religion, Enlightenment rationality (the loss of reason being associated with the loss of humanity) and even race (as we have seen with the “savage Indian” reference), and it is a distinction that, as I have said, was repeated over and over again by the essayists of the eighteenth century. We may fairly ask whether is there is anything in this distinction worth rescuing, or, to put the question another way, did anyone ever learn anything of true value from a visit to Bethlem, or must we look askance at every account of visiting?

Here are three further examples to set us thinking:

In 1632, the clergyman Donald Lupton wrote that Bethlem patients are “put to Learne that Lesson which many, nay all that will be happy, must learne: to know, and be acquainted with themselves” and that the Hospital “would bee too little, if all that are beside themselves should be put in here”. In 1717, a letter-writer to London’s Guardian newspaper (no, not that Guardian newspaper, another one) wrote of those of his fellow Londoners who do not take the opportunity to donate to the city’s hospitals in return for the privilege of visiting their wards: “The gay and frolick part of mankind are wholly unacquainted with the numbers of their fellow-creatures who languish under pain and agony for want of a trifle out of that expence by which those fortunate persons purchase the gratification of a superfluous passion or appetite”.

Then in 1743, a doctor from Lancashire by the name of Richard Kay wrote the following in his diary about his visit to London: “Mr. Sparrow and l took a Walk in the Afternoon thro’ the Galleries at Bedlam. Lord, May thy Goodness to us and kind Preservation of us always be had in thankful Remembrance by us.”

Now I appreciate that some of these lessons may seem a little remote to some of us insofar as they are cast in religious terms; but again I think it’s worth asking: does nothing of any value emerge from these insights, gained as they were on the strength of visiting the Hospital? Were any of the visits that inspired them worth it? Or to use a contemporary analogy: is there anything of moral worth in the clips showing celebrities visiting development projects in Third World countries that are shown on our screens as part of TV fundraising drives? What is the relationship between our access to such scenes and our willingness to give, and is it a healthy relationship?

Well, all I can do today short of actually answering these questions for you is to indicate that the answers are unlikely to be straightforward. If a straightforward affirmation of the motives of eighteenth century visitors to Bethlem was possible, presumably visiting would never have been restricted. Yet I do not think it is possible to dismiss all the published reflection about human society and human nature that arose out of the experience of visiting as prurient or patronising.

You may be interested to hear that just as scholarly debate rages over the phenomenon of visiting, so it does over something which could be seen as a parallel to it. In her book Regarding the Pain of Others, Susan Sontag argues against the commonly-held view that war photography necessarily feeds anti-war sentiment by its exposure of the atrocies of conflict. Any power such images may initially have to fuel moral outrage is quickly blunted by repetition, she writes, and actually become transformed into a force for moral turpitude, as we become acquainted with, then inured to, and maybe even incited by, images of death and violence. This position has been contested by authors such as Susie Linfield, who in the recent book The Cruel Radiance argues that it is possible and indeed morally necessary to learn to see the human subjects in war photography; that these people are not exploited merely by being photographic subjects, and the those who view the photographs are not brutalised merely by seeing them. All of which is a roundabout way of saying that the effect of war photography on people is complicated, because people themselves are complicated. In thinking about the practice of visiting, we should, I think, reject simplistic binary distinctions between persons of quality and persons of none, between those with finer feelings and those without. But I think there is something authentic, something worthwhile, for instance, about the unsettling insight achieved by William Cowper into his very self following his trip to Bethlem: “it was impossible not to be entertained, at the same time that I was angry with myself for being so”. I say this, and in fact, I have delivered this entire lecture, not to justify the practice of visiting, but to contextualise it and to assert that, however much it was subject to abuse, something of moral and social value did occasionally come out of it.

Those in the audience who have persevered with me thus far may remember that I began by drawing your attention to the way in which Bethlem has served as a ready metaphor for the various ills of English society. For hundreds of years, the things people have wanted to attribute to ‘Bedlam’ have not always been a true reflection of what life is really like at the bricks and mortar institution in London or its environs that I work for, and here’s the point – they weren’t ever meant to be. Instead they have formed a plank in an argument about the nature of our politics and our society. And whether the argument has had to do with the greedy directors of the South Sea Company or the lowest common denominator appeal of reality TV, it is an argument designed to shake people out of their moral torpor and begin to think and care about their society.

Before I invite questions, I want to conclude by citing two examples of this kind of argument, taken from the accounts we have been looking at. The first was written from the (fictional) point of view of a foreigner looking in at English society from without in 1736. After outlining the national characteristics that tend towards madness (called by the author ‘the English malady’), and describing at length the case of one of the patients he met while visiting Bethlem, the author turns his gaze away from Bethlem onto the nation:

“Were you to see the number of English people confin’d for lunacy in this public hospital and the private mad-houses, you would be surpris’d; but much more so, when you observ’d that the actions of those who perform their usual business were little better than mad… In this Bedlam there are kings, whose crowns and sceptres are straw, and whose dominions are a dark room, and whose subjects a million of fancies; but I must tell you, my dear friend, that there are sometimes real Kings as mad as these imaginary ones; whose dominions ought to be confined to a dark room, to keep them from doing farther mischief. Here are, again, numbers of people who are continually building castles in the air; but many more of these builders out of Bedlam than there are in.” This is not reportage, but social commentary from somewhere to the left of The Guardian, perhaps (yes, that Guardian this time). And in the interests of political balance, we should return to the anonymous correspondent to The World in 1753, who from somewhere to the right of The Telegraph indulges in some hand-wringing over the young hoodlums and rioters of his generation:

“I have frequently compared in my own mind the actions of certain persons whom we daily meet with in the world to those of the inhabitants of Bedlam…and I know of no other difference between them than that the former are mad with their reason about them, and the latter so from the misfortune of having lost it…these former unhappy wretches are suffered to run loose about the town, raising riots in public assemblies, beating constables, breaking lamps, damning parsons, affronting modesty, disturbing families and destroying their own fortunes and constitutions.”

There’s not as much here by way of genuine insight as we found in William Cowper. Here it’s more a case of using Bethlem as a rhetorical stick to beat your opponents with in the culture wars of the eighteenth century. As I have argued, this is a habit that has never really been lost. Yet I maintain that genuine insight is possible. There are currently plans for the small Archives & Museum at which I work to become a little larger so as to more adequately tell the story of mental health treatment in this country. The practice of unrestricted visiting at Bethlem will form an important part of that story. Right now we are in the exhibition planning and storyboarding stage, and we are toying with the idea of mounting lifting flaps onto the walls as if to replicate the experience of the eighteenth century visitor peering into patients’ room. The idea is that behind each flap will be pictures such as the ones I have shown you today, and that behind the last one in the sequence there will be a mirror, as if what people saw when they peeked into Bethlem was no-one other than themselves. I hope that you can see that there is a real sense in which this is true, and not only true but also valuable, if indeed Donald Lupton was right to say that the “Lesson” which “all that will be happy must learne” is “to know, and be acquainted with themselves”.

© Professor Colin Gale 2012

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