Bedlam is a social history of madness in England that loosely follows the 750-plus years of the Bethlem hospital. It depicts the dramatic shifts and reversals in the treatment of mentally ill people from the middle ages to the present, and also charts changing popular attitudes toward this often demonised and much abused minority of the population.
Catharine Arnold has not restricted herself to a narrow view of her subject. She has roved widely, and peppers her narrative with startling anecdotes and brief sketches of such characters as Henry Maudsley, "the gloomy genius of late Victorian psychiatry". Maudsley, who gave his name to the famous clinic across the road from King's College hospital in Camberwell, was a proponent of the view that insanity was hereditary, that it spelled the extinction of humanity, and that in the twilight of empire England had become the asylum of the world.
Elsewhere we read of that desperate evening in September 1796 when Mary Lamb "turned upon her mother with wild shrieks and stabbed her through the heart, before hurling the knives and forks around the room, one of which struck her helpless old father on the forehead". Lamb was not hanged and she did not end up in Bethlem. Her brother Charles had her confined in a private madhouse in Islington, where she made a full recovery. Later, like him, she became a distinguished essayist. But despite his sister's return to sanity Charles took no chances. After Mary's release, "the Lambs never left home without a straitjacket".
In a period when the psychiatric treatment of women in particular was often barbaric, Lamb's experience in the Islington asylum offers a rare instance of compassionate care. Others were less fortunate. Until the reforms of William Hood, who became medical superintendent of Bethlem in 1853, inmates were confined in conditions of filth and squalor, unsegregated by sex, chained to walls naked and freezing, physically abused by their attendants, and displayed to a jeering public like animals. A former patient, Urbane Metcalf, in the catalogue of horrors he produced on his release, mentions the case of a man called Popplestone, "whose leg rotted off as he was chained up for such a lengthy period that the metal cut into his flesh". There was also the infamous case of the American marine James Norris, so closely confined in chains, and for so long, that eventually his intestines burst.
Arnold occasionally makes wild claims. Discussing the great earthquake that terrified Londoners in 1750, and "brought out the incipient maniac in everybody", she writes: "Towards the end of the 18th century, the majority of press and parliament appeared clinically insane..." And a little later: "An extraordinary number of leading politicians were mad, by any standards, and a similar instability characterised the leading intellectuals of the day."
It's debatable whether the gentle, Keatsian melancholy she celebrates in the last pages of the book belongs in the same order of disease as, say, the psychotic illness of the artist Richard Dadd. He murdered his father in Cobham Park because he believed he was the devil. He escaped to the continent, intent on killing the emperor of Austria. Captured and locked up, in Bethlem and in Broadmoor, where he died in 1886, he sustained to the end his belief that he was possessed by evil spirits.
Or consider Charles Burton, who was admitted to Bethlem for killing his sister, with whom he had an incestuous relationship. Later he amputated his penis, "that it might not again get him with disgrace". The sufferings of Blake, Swift, Pitt the Elder and Dr Johnson pale by comparison.
A distinguished French scholar attributed the problem of madness in England to "the mixture of fogs, beef and beer aggravated by the rigours of nonconformity and the tedium of the English Sunday". Amusing asides like this cohabit uneasily with serious accounts of therapeutic and legal developments in the treatment of mentally ill people. This juxtaposition can make the book read more like a miscellany than a focused history with a thesis to argue. This is both the strength and weakness of Bedlam. It permits the author to indulge all that is quirky and macabre in the fascinating story of madness in England, but at the same time curtails exploration of topics that cry out for more detailed treatment.
Bethlem was founded in 1247 as a sanctuary, and became an asylum for the insane in the 1370s. It moved from Bishopsgate to Moorfields in 1676, and to Lambeth in 1815, where it remained until 1930. That building now houses the Imperial War Museum, and Bethlem is currently located in "the sunlit uplands of suburban Kent", in a country estate called Eden Park. To deal with any thoroughness with the history of this institution and a host of related topics requires a volume many times the size of this one. But Bedlam does provide an account of how painfully slow progress in the field of mental health tends to be, and how that progress has often been checked by fear and incomprehension, and even turned backwards in periods of therapeutic pessimism and institutional neglect.
· Patrick McGrath's most recent novel is Trauma
