Posted in Advocacy, Mental Health

‘Bedlam’s’ True Horror History

Today’s post is the first that looks into the history of psychiatry and ‘treatments’ for the insane, mad, mentally ill and neurodivergent, through a brief overview of the history of Bethlem. I think it’s important to share and learn about this history because it helps us to better understand the foundations and influences on psychiatry nowadays, and therefore understand the problems and potential solutions within the mental health system, including abolitionist approaches. I hope you find this little guide to be informing, let me know if you have any questions in the comments! Just a quick trigger warning for psychiatric violence and restraints.

Bethlem Royal Hospital was one of the first lunatic asylums. It’s horrifying history has inspired lots of books, movies and TV shows, most notably Bedlam.

So the real life horror in its history should be evident, otherwise why would it inspire such horror stories? Yet often we don’t stop to wonder about such histories that informed modern day psychiatry. It’s important to learn about this stuff because the legacies can still be seen nowadays in abusive, neglectful, and ineffective systems.

Bethlem was originally founded in 1247, and was linked to the Church of Bethlehem. It’s foundations are muddied and muddled – it was first used to house alms and poor people with religious ties and with the aim to make money. This monetary trend is also something we still see nowadays in many areas of life, including in the mental health system and coupled pharmaceutical industry.

It’s not known exactly when Bethlem was first used for the insane but is frequently assumed that this was from 1377. Management was through ‘keeperships’, with essentially sole control. Jumping ahead a bit, during Sleford’s keepership at the hospital (1579-1598) the buildings fell into disrepair – ‘so loathsomly filthely kept not fit for any man to come into the house’

However, living conditions didn’t exactly improve. Into the 19th century many inmates were left to sleep on straw beds and only permitted to go the toilet in their cells. Simultaneously financial exploitation by head physicians was common from the 17th century onwards – they were getting rich while the people inside suffered. In fact, in the 17th century several patients were found to be suffering from starvation, and staff practices were found to be a significant contributing factor to this. Staff practices are often a main complaint by inpatients today as well – but they are far too frequently brushed aside; once you’ve been labelled as unstable it’s incredibly difficult to reclaim your power and have your concerns legitimised.

While it appears restraints and solitary confinement were used for the insane at Bethlem from the start (and still today!), not a lot is known about so-called ‘treatment’ in the medieval period. However from 1460 the transition to a specialist institution for the insane was mostly complete and more is known from then on. In the 1680s cold baths were introduced as a form of treatment, as were incredibly hot baths later. Patients were bled, blistered, then dosed with emetics (make you vomit) and laxatives indiscriminately during the 18th century.

Perhaps one of the most disturbing parts of Bethlem’s history is that from the 17th century onwards visitors could pay to come and gawk at patients like animals in a zoo. Can you imagine the shame and anxiety of having your distress put on show as amusement for others? How could anyone possibly heal in that environment? We can infer from this a part of the pattern of control and benefit from locking mad people away rather than a genuine care for them as individuals and a desire for them to heal.

There was even an ‘Incurables Division’ added 1725-1738; patients in here could never hope to leave. One approach was rotational therapy: a patient was put in a chair suspended from a ceiling and spun at sometimes more than 100 rotations a minute

Experimental (read: unsafe) treatments were also used on patients at Bethlem. Furthermore modern investigations have uncovered mass graves on the property, dug exclusively for those who died under care at Bethlem.

This barely scratches the surface of Bethlem’s horrifying history of abuse and exploitation. The hospital is still in use today and many patients are still voicing their pain and trauma from their time there – restraints are still used, as are forced medication, and mad voices are not respected. There’s even a museum of patient’s artwork there, and while some exalt this as them respecting the patient’s expression, I have to wonder to what degree is it a modern day version of gawking st misunderstood minds?

We may have come a long way, but there’s still a lot further needed to travel.

Sources:

https://www.huffpost.com/entry/bedlam-the-horrors-of-lon_b_9499118/amp

https://en.m.wikipedia.org/wiki/Bethlem_Royal_Hospital

Porter 2006, Whittaker 1947 

Porter 1997 

Andrews et al, 1997 

‘A view of Bethalem’ 4th December 1598, quoted in Allderidge 1979

Posted in Advocacy, Mental Health

Over Pathologisation of Mental Health

We hear a lot nowadays about removing the stigma from mental illness, and that is incredibly important. After all, we all have mental health. But I also I think it’s essential while advocating in mental health spaces that we not only call for destigmatisation, but we also question the systems; call out the injustices of the systems meant to care for us. We must question whether medicalisation of mental health really helps us. Would it be necessary if our society wasn’t structured the way it is in the west? Does it further the link between mental illness and criminalisation? Because destigmatising mental distress isn’t only recognising that it exists, it’s asking why it exists, is the language we use to describe mental illness helpful, what does healing really mean, and how are we failing to learn the lessons from our madness? So here are some of my musings on the over pathologisation of mental health:

It individualises our pain without individualising our care – that is to say it tells us we are broken, it is our individual chemistry that is flawed, and we are to blame, yet also not putting us at the forefront of understanding our pain and choosing how we heal. It tells us we are too sick to know what’s really good for us, or that we don’t know ourselves well enough. It doesn’t allow us to learn who we are and what’s really at the root of our pain; doesn’t encourage us to put it into a sociopolitical context, and the context of what has informed our life. Doesn’t allow us to heal with others.

There is no community. No value given to peer support, to healing with others who are experiencing the same things or similar things or completely different things, but feel safe to heal with. Doesn’t encourage the connections that are vital to long term healing and alternative methods of care. If you want proof that peer support methods of healing work, look at AA – it revolutionised care for alcoholics. What was a death sentence became an opportunity for hope and healing.

Our pain is shunned and labelled, pathologised. Instead of learning to embrace the madness as part of who we are, we learn shame which in turn births more pain. Instead of learning to see mental distress as a natural human reaction, however difficult, we learn to be afraid of it. Language that could be used to free us is instead weaponised against us to strip us of our wholeness and our identity through clinical rotes.

But it doesn’t have to be that way. I don’t have all the answers. I listen to psychiatric abolitionists and I think, yeah, they have the answer. I listen to amazing healers in other cultures outside of the west and am filled with inspiration and hope. Then I look back at the world as it is and wonder if we don’t need to adapt our goals to be a little more realistic within the current frame of society here in the UK. I don’t have the answer nor a clear label for my ideology surrounding this all. But I do have hope. And I do know things are already changing. 

We don’t have to wait to build communities. We don’t have to wait to create new ways of healing. We don’t have to wait to find hope. 

You can also find a version of this post on my Instagram @our.happy.notes