Bethlem Royal Hospital today

History about Bethlem

A London hospital originally intended for the poor suffering from any ailment and for such as might have no other lodging, hence its name, Bethlehem, in Hebrew, the "house of bread." The word Bethlehem became shortened to Bedlam in popular speech, and the confinement of lunatics there gave rise to the use of this word to mean a house of confusion.

Bethlem has been a part of London since 1247, first as a priory for the sisters and brethren of the Order of the Star of Bethlehem. Its first site was in Bishopsgate Street (where Liverpool Street station now stands). In 1330 it became a hospital, and it admitted the mentally ill in 1403 but there were only nine patients. Early sixteenth century maps show Bedlam, next to Bishopsgate, as a courtyard with a few stone buildings, a church and a garden.

The attitude of successive generations of Englishmen towards the insane can be traced interestingly at Bedlam. Originally, it was founded and kept by religious. Every effort seems to have been made to bring patients to such a state of mental health as would enable them to leave the asylum. An old English word, "a Bedlam" signifies one discharged and licensed to beg. Such persons wore a tin plate on their arm as a badge and were known as Bedlamers, Bedlamites, or Bedlam Beggars
 
Conditions were most often dreadful, and the care amounted to little more than restraint. There were 31 patients and the noise was "so hideous, so great; that they are more able to drive a man that hath his wits rather out of them." Violent or dangerous patients were manacled and chained to the floor or wall. 

It was a Royal hospital, but controlled by the City of London after 1557, and managed by the Governors of Bridewell. Day to day management was in the hands of a Keeper, who received payment for each patient from their parish, livery company, or relatives. In 1598 an inspection showed neglect; the "Great Vault" (cesspit) badly needed emptying, and the kitchen drains needed replacing. There were 20 patients there, one of whom had been there over 25 years.

Bethlem Royal Hospital became famous and infamous for the brutal ill-treatment meted out to the mentally ill. In 1675 Bedlam moved to new buildings in Moorfields designed by Robert Hooke, outside the City boundary.

In the 18th century people used to go there to see the lunatics. For a penny one could peer into their cells, view the freaks of the "show of Bethlehem" and laugh at their antics, generally of a sexual nature or violent fights. Entry was free on the first Tuesday of the month. Visitors were permitted to bring long sticks with which to poke and enrage the inmates. In 1814, there were 96,000 such visits. The lunatics were first called "patients" in 1700, and "curable" and "incurable" wards were opened in 1725-34.

Eighteenth century Bethlem was most notably portrayed in a scene from William Hogarth's A Rake's Progress (1735), the story of a rich merchant's son whose immoral living causes him to end up in a ward at Bethlem. This reflects the view of the time that madness was a result of moral weakness, leading to 'moral insanity' to be used as a common diagnosis.  Hogarth's famous picture represents two fashionable ladies visiting the hospital as a show place, while his "Rake," at the end of the "Progress," is being fettered by a keeper.

In 1815, Bedlam was moved to St George's Fields, Southwark (into buildings - designed by Sydney Smirke - now used to house the Imperial War Museum), where the inmates were referred to as "unfortunates." This building had a remarkable library as an annex which was well frequented. Although the sexes were separated, in the evenings, those capable of appreciating music could dance together in the great ballroom. In the chapel the sexes were separated by a curtain.

Finally, in 1930, the hospital was moved to an outer suburb of London, on the site of Monks Orchard House between Eden Park, Beckenham and Shirley.

Bethlem Royal today

Bethlem Royal Hospital is now part of the South London and Maudsley NHS Foundation Trust ("SLaM"), along with the Maudsley Hospital in Camberwell.

SLaM is provider of the most extensive portfolio of mental health services in the United Kingdom, and a world leader in research, working in partnership with the Institute of Psychiatry, King’s College London

SLaM provides mental health and substance misuse services to people from Croydon, Lambeth, Southwark and Lewisham, together with substance misuse services for Bexley, Greenwich and Bromley, along with national specialist services, eg the National Psychosis Unit. There are a range of services at the Hospital, from substance misuse and eating disorders services to units for children and adolescents.