Disability History Month: Accessibility and Archives: “A night that never ends”?
In this blog for Disability History Month, David Luck from Bethlem Museum of the Mind shares some of the history of that institution, not so much as a place of care and treatment, but as a vivid public spectacle inspiring the imagination of artists and dramatists. These representations may tell us more about how madness was (and is) perceived, than how people were being treated. They also remind us how difficult it is to tell this disability history in other contexts – it is not just in theatres that an audience can bring a ghoulish gaze, deriving entertainment from the reported suffering of others.
Bethlem Hospital, or its sinister alter-ego ‘Bedlam’, made its first appearance in popular culture from the mid-1550s or so. On one level this is hardly surprising- the Hospital had been specialising in caring for psychiatric issues since the early 1400s, and it was well-known that it had finally fallen into the control of the Corporation of the City of London’s in 1547. Both bedlam and Bethlem were derived from ‘Bethlehem’, reflecting the origins of the Hospital as an outpost of the ‘Order of St Mary of Bethlehem’, a Christian Crusader order who established a priory and then a hospital on the edges of London in 1247.
However, while the Hospital seems to have kept to the name Bethlem continuously, it was the reputation of ‘bedlam’ that captured the cultural imagination from the Elizabethan period onward. Edgar disguises himself as a poor ‘Tom O’Bedlam’ in King Lear, and this reflected statutes in Tudor poor law that allowed former patients to be licenced beggars. There are ‘bedlams’ and ‘bedlamites’ in four Jacobean plays, including Northward Ho by John Webster . By 1610 the doctor and mystic Richard Napier had started to refer to his patients in the midlands with severe mental health issues as ‘Bedlam Mad’, meaning their symptoms were so severe they could qualify for care in the infamous ‘mad-house’ in London.
This growing cultural cachet associated with the word ‘bedlam’ seems to have been entirely out of kilter with the reality of Hospital itself. What was really a higgledy-piggedly precinct of crumbling medieval buildings that could perhaps house thirty patients started to appear in the English language as a synonym meaning chaos, confusion and a place of madness itself.
Carol Thomas Neeley has written that the bedlams depicted by a range of authors usually function as a macabre comment on the wider societies they are part of, which are usually set in countries like Spain and Italy (partly to avoid appearing to directly criticise the English ruling class). Neeley writes that the scenes involving the mad are often metatheatrical, often featuring performances or plays, that satirise attacks on the theatre by role-playing these complaints as the rantings of the mad.[1]
Bethlem was itself part of London’s entertainment scene, a place where one could pay for admission. When this began is a source of some controversy, as the first potential reference to it occurring is 1610. Neeley makes the point that the ‘unreality’ of bedlams onstage implies that London’s theatre community may have been familiar with its reputation, but didn’t actually visit despite the close proximity of many playhouses to the first hospital just outside the walls of the City in Bishopsgate. However, paying visitors were certainly authorised and established by the time it moved to the first purpose-built hospital building in Moorfields, which opened in 1676.
Charging for visitors was almost certainly a way for the Hospital to drum up much needed cash, as it was a charity dependent on donations and bequests to keep running. In practice though it almost certainly bought ‘bedlam’ closer to ‘Bethlem’, as crowds gathered to watch the ‘lunatics’ in the Hospital. Early histories have almost certainly exaggerated the numbers and the cultural impact of those visitors - Michael Macdonald’s estimate of 90,000 per year appears a gross exaggeration for example - and ignores the fact that it was never uncontroversial. In the seventeenth century to lose one’s mind was to lose one’s humanity, but even then the Hospital was often criticised for allowing people to gawp at the ‘poor objects’. The move by the Governors to a licenced form of visiting in 1770 was a response to the moral opprobrium placed on them as society moved toward a different understanding of mental health.
The most famous contemporary Georgian image of ‘Bedlam’ that we have is the final panel of the Rake’s Progress by William Hogarth (see preview image). This is both recognisably evoking a real place but also an exaggerated, perhaps even theatrical scene, sharing with us what the two visitors are seeing (or imagine they would see), making voyeurs of us too. Are we sympathising with the patients, or are we really just enjoying the show?
The title of this blog is drawn from a chorus of Bedlam Madmen in Stravinsky’s opera The Rake’s Progress (libretto by W H Auden). Inspired by the sequence of paintings and prints by William Hogarth, this is just one instance in a rich, and problematic, ongoing stage history depicting Bethlem madness. More recently, the play ‘Bedlam’ by Nell Leyshon, which opened at Shakespeare’s Globe in 2010, sought to critique and satirise the grotesque attitudes of the Georgian public toward mental health. A sense of exploitation is bought front and centre in Leyshon’s play, and it is hard to argue with making these outdated and inhumane practices a target. However, there is also a sense that the audience is complicit within this - we too are paying visitors to bedlam, and we too are looking for a good time.
Some of the more perceptive reviewers also noted an uncritical acceptance of what came after[2]. The asylum system that came out of bedlam was a reaction to the theatre and cruelty of Georgian attitudes, and yet is also deeply problematic in its own terms. Current historical theory depicts an era of medical incarceration where individuals lived out controlled lives in unseen institutions. Leyshon spoke to professionals at the modern day Bethlem Royal Hospital while creating the play, but it’s almost as if the effect of this was to cement a belief in a whiggish sense of progress in psychiatry.
Psychiatry has too contested and thorny a history for this certainty to ring true. At Bethlem Museum of the Mind, located onsite at the modern-day Bethlem Royal Hospital in Beckenham, we attempt to find through lines in history, to explain how we have arrived where we have with treatment methods, and we hopefully avoid telling a story of progress to some imagined bright future. Many of our visitors are service users onsite in the Hospital, and we believe it is not enough to tell people who may have been secluded and restrained in their own treatment that these things are in the past. A narrative that the past is bad and the future is good feels dishonest in this context; the history is much less black and white, and is much more interesting and nuanced than this.
Cover image: William Hogarth: A Rake’s Progress Plate VIII “In Bedlam” courtesy of Yale Center for British Art
[1] Carol Thomas Neely, ‘Distracted Subjects: Madness and Gender in Shakespeare and Ealy Modern Culture’, Cornell University Press, 2004 p.187
[2] See some of the criticisms summarised here- https://museumofthemind.org.uk/blog/curatorial-conversations-i accessed on 21.10.2025