From Bedlam brutality to Royal confessions: A brief history of mental health in Britain today

An arresting sculpture greets visitors as they enter the Bethlem Museum of the Mind – an archive and art gallery in the 270-acre grounds of Bethlem Royal Hospital in Beckenham, south London. 

Flanking a grand, Art Deco staircase in the museum’s hallway rests two statues carved from Portland stone in by the Danish sculptor Caius Gabriel Cibber in 1696, and which once sat atop the entrance gates of an infamous former incarnation of the place known to Londoners as ‘Bedlam’.

Entitled Raving and Melancholy Madness, the sculpture depicts one figure writhing on his back, chained and bearing a desperate grimace; on the other side, his doppelganger is dead-eyed, lying prostrate and heavy. 

In the 17th century, Cibber’s sculptures were a representation of the two predominant diagnoses for sufferers of mental illness in Britain at the time: you were either raving mad, or you were melancholy mad. In 2017, though, seeing them serves as a stark reminder of just how far we’ve come. 

Today marks the 25th annual World Mental Health Day, a celebration now recognised by more than 150 countries around the globe designed to raise awareness of issues surrounding all facets of mental health and wellbeing. 

In Britain, this year’s event will be the biggest ever, and includes a reception for mental health workers at Buckingham Palace to be attended by the Duke and Duchess of Cambridge and Prince Harry. Last week, a study of the impact made by the young royals’ awareness campaign, Heads Together, showed more Britons talking about mental health than ever – including 1.2 million more men. 

Featuring unsparingly honest interviews with the royals, celebrity spokespeople and the London Marathon, the campaign came in a year in which everybody from the Theresa May to the Pope spoke about the importance of mental health issues. Just months ago, too, health secretary Jeremy Hunt promised an extra ￡1.3bn will be invested in mental health services annually by 2021.

Little by little, stigma is being shredded, attention paid and conditions understood. It has been a long time coming. 

As the first and oldest institution for the treatment of mentally ill people in Europe, Bethlem Hospital is uniquely placed to tell the story of mental health in this country. The leafy, NHS-run establishment visitors can explore today is the fourth incarnation in its more than 700-year history. The first was at Bishopsgate, now the site of Liverpool Street Station, where it was founded as The Priory of the New Order of St Mary of Bethlem in 1247. Initially it served as an almshouse, but over the next century it morphed into a general refuge – or, to use a word later corrupted, an asylum – that earned a reputation for welcoming the city’s ‘mad’.

Almost exactly 68 years ago, the Nobel Prize for Medicine was won for developing an early version of the frontal-lobe lobotomy

At that time, to be ‘mad’ could have meant a lot of things: those cast out from families for being believed to be demonically possessed, or those gravely disturbed by a tragedy, or just vice-ridden ‘sinners’ causing trouble around town. All could have been admitted to Bethlem, but quite how they were dealt with in the hospital’s earliest form is uncertain. Given the presence of manacles, chains and locks dating from those years, however, it seems restraint – and keeping them off the streets by force – was the go-to method of treatment. 

Still the only large institution for mentally ill people in the country by the Jacobean period, Bethlem became infamous in London as an over-crowded, rowdy place. The name soon twisted to ‘Bedlam’, which stuck. Shakespeare and Webster, two of the pre-eminent playwrights of the time, referenced Bedlam in their work, and the word would consequently go on to be fixed as a noun representing any disorder and chaotic uproar anywhere.

After the Great Fire in 1666, the hospital briefly moved to a larger home in Moorfields, near to where the eye hospital is today. The new structure was one of the most admired buildings of the age: more open, more green, and had Cibber’s statues looming out over the streets. And all three of those aspects were, chiefly, to attract tourists.

In a practice seen as deplorable by modern standards, by the end of the 17th century, desperately trying to raise money – and, in part, to show people why they needed money – the hospital invited members of the public to pay and witness patients from special galleries. The staff, by this time, consisted of nurses, hospital workers and a few doctors, but they had no real treatments for ‘maladies of the mind’ or any great understanding of them. Instead, cold baths, set meals, induced vomiting and frequent blood withdrawals (believed to rid the patient of imbalances, but also to weaken the troublemakers) were rotated ad nauseam. Little had moved on from the binary distinction of ‘mad or sad’.

Come the end of the Georgian era, Bethlem relocated again, taking up residency south of the river in St. George’s Fields in Southwark. The new building was imposing, ordered and divided for the first time into entirely split wings for men and women. That composition reflected the Victorians’ greater scientific understanding of mental health – relatively, anyway – and intention to control it by any means necessary. 

By now, of course, Bethlem was not the only mental hospital in the country. Eight other asylums existed by the turn of the 19th century, and the 1774 Madhouse Act saw ‘lunatics’ cared for in private institutions run by non-medical men looking for profit. As such, those buildings were rife with overcrowding and mistreatment as it was far easier to simply chain patients up. Later, the second County Asylums Act in 1845 meant huge Victorian asylums – the kind horror movie directors so adore – sprung up all over the country. The majority of those buildings existed as hospitals until at least the late 20th century, including Whittingham Hospital in Lancashire, which housed almost 3,000 patients at its peak.

Countless photographs of patients exist from the Victorian era of mental treatment. This is in part due to the technology’s youth, but also because some doctors believed a photograph could capture mental illness in a single frame, thereby helping with diagnosis. The ‘insane’ patients sent to Victorian asylums could have included alcoholics, women with post-partum depression and ‘hysterical’ unmarried women, those with anxiety disorders and people with dementia – all of whom were made to feel a shame. Though many of us recognise the nuances in different kinds of mental illness at a distance today, however, Victorian society did not know the names – or, indeed, concepts. 

In the early 1900s, two reformers, Frenchman Philippe Pinel, the founder of ‘moral treatment’, and William Tuke, founder of the York Retreat, introduced some of the earliest examples of real compassion regarding mentally ill patients. Pinel, for instance, believed ‘mad’ people “would improve if they were treated with kindness and consideration,” rather than brutality and isolation. 

Still, kindness and consideration never overburdened the government-run asylums. Those inside were still treated more like prisoners than patients, and reports by inspectors regularly found conditions to be abhorrent. In part, this was simply due to them being very full. The rigours of the industrial revolution meant asylum numbers swelled to more than 100,000, putting considerable strain on the few staff available.

Later in the century, the situation in American asylums was brought to the public by the work of Nellie Bly, then a young undercover journalist, who went pretended to be insane in order to write an expose of a women’s asylum. Rats, hair-pulling, solitary confinement and no comforts – Bly’s report, turned into a book, shocked America into reform.

Around the turn of the 20th century, Sigmund Freud and other psychoanalysts began to present theories as to why people think differently, and how to help them. Freud’s theories related to the talking cure and individual psychotherapy, but in the underfunded and overcrowded asylums themselves, increasingly radical procedures were suggested. Many are seen as despicable and arrogant today, but at the time breakthroughs were greeted as miracle cures, even if they incapacitated patients.

The ‘insane’ patients sent to Victorian asylums could have included alcoholics, ‘hysterical’ women and people with post-partum depression, anxiety disorders and dementia cases

Almost exactly 68 years ago, in fact, Portuguese neurologist António Egas Moniz won the Nobel Prize for Medicine for developing an early version of the frontal-lobe lobotomy, the process of making an incision in a patient’s skull and cutting the connections between the frontal lobe and the rest of the brain. That procedure was widely used all over Europe and North America for a few decades, until the medical community realised just what it was doing to people.

"It reflected very bad medicine, bad science, because it was clear the patients who were subjected to this procedure were never followed up properly,” Henry Marsh, the celebrated British neurosurgeon, once said of the lobotomy. "If you saw the patient after the operation they'd seem alright, they'd walk and talk and say thank you doctor. The fact they were totally ruined as social human beings probably didn't count."

Bethlem moved again in the 1930s, this time further south into the fields of Beckenham, where it stands today, giving up its Southwark site to the Imperial War Museum. Shortly afterwards the war, incidentally, played a major role in pushing things forward. Some historians note the significant impact the two conflicts had in waking the medical community up to the impact of environmental factors in mental health. When doctors saw post-traumatic stress disorder in soldiers, especially those not exposed to shell-fire (the original belief was that shells were severing nerves in the brain, hence ‘shell-shock’), they were able to connect it to what they termed ‘battle fatigue.’

The US Army even used the slogan, “Every man has his breaking point” before the end of the war, marking a drastic change in attitude. Though it took decades to truly take hold, it dawned that anybody could exhibit symptoms of becoming mentally ill – and could potentially suffer in silence. Ever watchful pharmaceutical companies took note, but upper lips stiffened considerably.

Number of people suffering from mental illnesses (per 100 people)

The Victorian asylums are largely gone now, but Bethlem continues to change with the times. The site today, with its museum and gallery, fields and woodland, is remarkably pretty, and completely welcoming of the public. Anybody can wander its grounds, where patients might be found engaging in horticultural therapy, practicing art, or having a walk. 

As it always has, the setting speaks to the attitudes of the day. And in 2017, when we know that mental illness affects one in four of us, and when even the future king of England wants to "smash the stigma", the message is one of openness and inclusivity: there is nothing to hide any more.