• Thảo Mac

The Age of the Mental Asylum in England

In 1247, a wealthy politician named Simon FitzMary donated a piece of land in London to build a hospital. Its official name was the Bethlehem Hospital - part of the Priory of St. Mary of Bethlehem, but many Londoners simply called it, “Bedlam" - "a palace for lunatics".

Bedlam asylum was allegedly a physical manifestation of a nightmare. Its treatments of mentally ill patients were well-known for their inhumanity. But to be fair, the nightmarish treatments began far earlier than 1247. For a large part of history, mental disorders were often confused as a breakdown of the magical-religious system or worse - demonic possession. Therefore, ancient mental treatments resembled exorcisms more than medical care and sometimes even led to patient’s deaths. However, the patients themselves were not the only ones to suffer, but their families as well. Due to the misconception surrounding mental health since prehistoric times, there were prejudices towards mentally ill patients and their families. To avoid slander, most families would treat – or confine – their unstable family members at home. Still, there was no guarantee that such secrets would stay forever buried.

Bedlam, and other public mental asylums that came afterward, offered an alternative. Even though it began as a charitable hospital for the poor, by the mid-fourteenth century, Bedlam was rumored to only accept patients with mental disorders. This rumor came true at the beginning of the fifteenth century. By this time, Bedlam was known to specialize in “madness” – though the definition of the term was a bit loose.

During the Tudor dynasty, many symptoms were considered “mental illness”. Other than obvious symptoms such as suicidal thoughts and self-harm, refusal to pray, sexual urges, talkativeness, and - the cherry on top - “hatred of spouse” were also categorized as symptoms of mental illness. Those who could afford it often sought help from various questionable practitioners – from physicians and herbalists to astrologers and exorcists. Those who were less fortunate, having no one who cared for them, ended up in Bedlam.

Due to the prejudices against mental illness, mentally ill patients were referred to as “inmates” and Bedlam, their prison. Physical restraints, such as chains and strait-waistcoats were common sights. Keepers acted more as guards than as caretakers. They had little medical knowledge and therefore did not hesitate to beat patients. The sounds from Bedlam were described by Donald Lupton as “cryings, screechings, roarings, brawlings, shaking of chains, swearings, frettings, [and] chaffings.” But these were only restraints to control patients. The nightmare did not stop there.

Being a “mental asylum”, of course, Bedlam also offered treatments for mental illness. With limited knowledge of science at the time, they believed that sanity could be “scared back” into patients. Thus, the treatments were fear-inducing: bloodletting; hydrotherapy – in other words: cold water bathing; confinement in harnesses; swing chair therapy – referring to a rotating chair spun at 100 times per minute. Considering the definition of “madness” at the time, this meant that many “patients” confined in Bedlam were likely not mentally ill. Nevertheless, they were all subjected to the same atrocities.

For several centuries, Bedlam was the only place for common folks with mental illnesses in England. Its tales of madness inspired numerous Renaissance literary and theatre works and even attracted tourism. The madhouse of London offered tours for adventurous visitors, where they could witness famous Bedlamites such as Mary “Moll Cutpurse'' Frith. Not only did these tours serve as twisted cautionary tales and moral lessons, but also as a fundraising act since Bedlam remained a charity-funded institution.

Bedlam dominated the landscape of mental asylums in England up until the eighteenth century. By then, private institutions were built for rich folks to hide their mentally ill relatives. However, the poor still had to rely on local parishes and publicly funded asylums such as Bedlam. The “treatments” started to vary between different asylums, yet remained largely demoralizing and brutal.

It took the death of a patient for things to eventually change. In 1823, a patient named William Scrivinger, was found dead at the Lincoln Asylum, strapped to his bed in a straitjacket. The asylum was forced to abolish physical restraints, marking the beginning of the 1800s asylum reforms pioneered by Harriet Martineau, William, and Samuel Tuke.

The reforms called for the authority’s responsibilities towards the care of mentally ill patients and aimed to abolish the prejudices surrounding mental health. For the first time, mental asylums were not to be treated as prisons, but as actual facilities where humane and science-based treatments took place. Furthermore, mentally ill people were to be treated as human beings, not as inmates or tourist attractions.

A new model of mental asylum was set up by William Tuke in York at the end of the eighteenth century. It became publicly known as The Retreat, where he experimented with moral treatments for patients with mental illness. The work was continued by his grandson - Samuel Tuke, who summarized their system in a book called “A Description of the Retreat”. The moral treatments of the Tukes aimed to treat patients as ordinary and rational people. They were divided into groups with similar behaviors and encouraged to participate in regular chores, to make polite conversations, and so on. Simple rewards were given to patients and physical restraints were only used as a last resort.

These moral treatments were further improved upon at Hanwell Asylum, where a non-restraint system was applied. Run by Dr. William Charles Ellis with his wife, and later by John Conolly, the Hanwell system administered “therapeutic employment” to their patients. Dr. Ellis believed that hard work was an essential part of rehabilitation, therefore his patients were all assigned various employments, from farming and baking to brewing. He also required the asylum staff to possess not only medical knowledge but also professional training to deal with aggravated patients without causing harm to either side. The system proved to be effective as it kept Hanwell self-sufficient and provided patients with a sense of community and normalcy.

The Hanwell model was widely adopted in the nineteenth century and soon became the new standard for public asylums. Old madhouses, such as Bedlam, were torn down. But as time progressed and the size of asylums grew, the Hanwell model proved to be ill-fitted for a large institution. At Hanwell, where the model was first established, the gloom grew when punishments were brought back to instill control over a large number of patients. Soon, it was clear that the asylum was no longer successful like it once was.

By the beginning of the twentieth century, the term asylum gradually became unpopular with the public due to the horrific treatments the patients had to endure. As a result, Hanwell asylum was renamed “Hanwell Mental Hospital”. A decade later, it was once again renamed “St Bernard’s Hospital”, and all associations with the old asylum were erased. The same happened with numerous asylums across England, both public and private, signaling the end of the Age of the Mental Asylum. Instead, a new era of science-based treatments for mental health began.


Speaking Plainly:

  • The Bethlehem Hospital was built in 1237 as a charitable hospital for the poor in London.

  • By the fifteenth century, Bedlam specialized in treating people with mental disorders; there was however no fixed definition of “mental disorders” at this time.

  • The mental health reforms of the 1800s started after the death of a patient due to brutal treatment.

  • In the nineteenth century, new moral treatments were installed in public asylums.

  • By the mid-twentieth century, most asylums were torn down or renamed as psychiatric hospitals, ending the Age of the Asylum in England.