A byword for pandemonium

HISTORY: ONE SIMON FITZMARY, who had a particular veneration for the Blessed Virgin Mary and the Star of Bethlehem, as a result…

HISTORY:ONE SIMON FITZMARY, who had a particular veneration for the Blessed Virgin Mary and the Star of Bethlehem, as a result of his experiences as a crusader, founded, in 1247, Bethlehem Hospital in Bishopsgate, in the heart of the City of London.

The local pronunciation of the name of the institution abbreviated it to "Bethlem". It became, in the 14th century, the particular facility which catered for "the mad". The author explains that "the term 'mad' is not intended to cause offence, but to reflect the generic use of the word, reserving explicit clinical terms for the appropriate context".

The conditions at Bethlem were grim. So much so that by Shakespearean times the atmosphere within the institution had given rise to the word "bedlam", which has entered the English language as a byword for pandemonium. That in itself gives some indication as to how far removed the daily life of the inhabitants of Bethlem was from those "sane" people who lived outside.

In 1666, the Great Fire spared the ramshackle building but shortly afterwards it was replaced by a "New Bethlem", built close by, at Moorfields, at a stretch of the ancient Roman London wall. It had a grand-palace-like exterior but it was shoddily built. It, in turn, had to be replaced by the beginning of the 19th century. The new hospital was erected in Southwark. It lasted until 1930 when a further new location was found in "the sunlit uplands of suburban Kent" and the Southwark building became the Imperial War Museum.


Although the author attempts to give some indication of what it must have been like to be an inhabitant of the institution in its first five centuries, the weakness of the book lies in the paucity of primary material to make the narrative reverberate. This difficulty is compounded in that the book is silent as to what were comparable living conditions of the so-called "sane" population. There are many references to various corrupt officials, but corruption of itself does not describe its negative consequences. The reader is left somewhat adrift.

By the beginning of the 19th century there emerges a world which is more comprehensible to a contemporary reader. In addition, there were reformers in the mid-19th century who believed in moral treatment for patients, the abolition of physical restraints and that the criminally insane should be housed separately. As a result, in 1863, the first establishment for the criminally insane, Broadmoor, was established in the then distant county of Berkshire.

BY THE 20th century we have the creation, through military inhumanity, of the condition which came to be known as "shellshock" in the first World War. To the class-ridden world of post-Edwardian England, it came as an unpleasant truth that the young public school officers were "isolated, facing a war for which no amount of drill or immersion on the military tactics of the Classics could have prepared them" and they "succumbed at twice the rate as the ranks". However, "shellshock" helped bring about a debate amongst professionals as to what is an appropriate approach for the treatment of mental illness, however caused. This debate continues.

The recent Irish Times leader of August 5th highlighted the 2007 Annual Report of the Mental Health Commission in this country. The commission was established under the Mental Health Act 2001, the terms of which were fully implemented in 2006. The report identifies the reduction of approximately 25% in the number of persons admitted involuntarily to an approved centre on the grounds of a mental disorder. The use by the author of Bedlam, of terms such as "mad" and "sane", while understandable in the context of writing about history, makes it an uncomfortable read when contrasted with the 2001 Act and the 2007 Report. Learning about and understanding mental health remains a major challenge for us all.

John McBratney is a barrister

Bedlam: London and its Mad by Catherine Arnold. Simon & Schuster, 306pp. £14.99