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Can two sides in a debate - both composed of sincere, intelligent people - look at precisely the same set of evidence and reach precisely opposite verdicts? With the Church of England's first women bishops to be named soon following the final seal of approval for legislation allowing them, that is exactly the case.


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Bethlem was founded in and through most of its history reflected contemporary views on the treatment and care of people with a mental illness. There was, however, a darker period when the hospital became more conservative, secretive and, eventually, abusive in the treatment of its patients. For most of its history Bethlem was the only dedicated mental institution in Britain, which automatically made its medical staff the foremost experts in the diagnosis and treatment of mental illness.

All mental illness, it was thought, could be cured by inducing recurring bouts of vomiting and diarrhoea, and by bleeding from the veins. The skin would be blistered with caustic substances and patients would have their he shaved and be placed in cold baths. It inevitably led to deaths.

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This treatment was still universally accepted inas Bethlem moved from its cramped medieval building at Bishopsgate into a magnificent and ornate hospital at Moorfields. Bethlem had space for just over patients and a long waiting list for admissions.

This was located directly opposite Bethlem, with William Battie serving as its chief physician. The two doctors battled publicly and promoted their views in books which, rather bizarrely, were widely accepted as being simultaneously correct.

It was not just the views of the doctors that separated the two hospitals, however.

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At the heart of patient care was a clean, calm environment. It is from their writings that we get a glimpse at what conditions inside Bethlem were like for visitors and patients. The of diarist Ned Ward is typical. He visited Bethlem in and found himself immersed in a terrifying world of noise and disorder. With the patients locked in their cells, Ward was able to other visitors in making taunts and jeers through the bars and peepholes. Some inmates were verbally insulted while others were goaded into doing or saying ridiculous things.

However, 18th-century medicine dictated that madness robbed the individual of shame, emotion and reason to the extent that any verbal or physical abuse they suffered could surely have no lasting effect.

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It was not just tourists who were drawn to Bethlem. Intermixed with the cacophony, smells and sights of the wards were prostitutes, pickpockets and merchants of food, drink, trinkets and other wares. Despite this, Londoners loved it.

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Year on year visitor s increased, leading to overcrowding, especially during the Christmas and Easter periods. Fromto limit riotous behaviour by both visitors and patients during seasonal holidays, admission was gradually tightened; by the s, outside access was only possible if accompanied by a hospital governor or senior officer.

But it also had an unexpected downside. Public admission allowed anyone to come and make their own judgement on the conditions inside Bethlem. After the ban, the hospital operated behind closed doors with its facilities, care and medical practices operating unobserved and unregulated. Bethlem soon found itself at the centre of a major financial embezzlement which, together with a general drop in income, placed it in debt.

The state of the building, which had been hastily erected in just over two years, was also of concern. It had always suffered from being damp and cold, but increased instances of subsidence and leakage led to a surveyor declaring the edifice to be falling apart. Violence was commonplace and so many patients were chained either to their beds or to the walls.

Adding to the misery was a lack of clothing and heating, rats, and medical officers whose adherence to debilitating purgative cures had become increasingly out-of-step with contemporary thinking.

Bethlem royal hospital: why did the infamous bedlam asylum have such a fearsome reputation?

As the 19th century dawned Bethlem remained outwardly visually magnificent while inside it had become a dilapidated, cash-starved institution operating without any ability or scrutiny. With no inspectors or even outside visitors to check on the patients, conditions were squalid and abusive. To be sent to Bethlem was no longer just a matter of shame, it also presented the serious risk of injury or even death.

Nor was there much prospect of being cured. The doctor, Thomas Monro son and grandson of incumbentspreferred collecting art to medicine.

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There were reports of widespread alcoholism, of buckled ceilings and walls and of male staff making improper visits to the female galleries. Developed by Erasmus Darwin, grandfather of the famous Charles Darwin, rotational therapy usually involved placing a patient in a chair suspended from a beam by ropes attached to its legs. The chair would be turned times one way and allowed to spin back to its original position. The swing chair could also be used as punishment — a way of asserting dominance over patients who refused to comply with staff orders.

Patients could be submerged in cold water for long periods of time, wrapped in towels that had been soaked in ice, or sprayed with cold water.

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In the 18th century there was little understanding as to the causes of mental illness and patients — whether depressive, manic or paranoid — received the same course of treatments. Caustic substances were also applied to the skin, to make it burn and blister. Away from Bethlem, the discovery of similar conditions elsewhere, most notably the York Asylum, had led to the development of a coherent reformist movement whose influence was beginning to be felt inside Parliament.

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Inside the building it was stark, dirty and cold, with no glazed windows or hot water. In those parts that were habitable MPs found small, fetid cells populated by several people chained to walls or their beds. The sight Bbc looking 4 St paul female most shocked the committee was that of James Norris, described as a clear and lucid man, who had been tightly chained by his neck to an iron bar in the wall. With additional metal restraints on his chest, waist, feet and arms, Norris complained that his muscles were atrophied and painful following a decade of confinement.

The staff described Norris as violent and dangerous but to the MPs he seemed quiet and perhaps even sane. The inspectors had seen enough and called for a Parliamentary inquiry into conditions at Bethlem. During the inquiry the medical staff fared poorly, with the apothecary blaming others for the squalor while the doctor, Thomas Monro, argued that nothing the MPs had seen was amiss.

The drunken and insane surgeon, Crowther, could not be interviewed as he had died a few weeks ly as had James Norris himself. It was an act of defiance that enraged reformers, but not the House of Lords, which blocked attempts at bringing Bethlem under official regulation. Lessons had been learned and the combination of a new building and new staff members brought about reforms of the sort that Wakefield and others had been calling for.

A financial audit suggested that the hospital was solvent and generally well-managed. Patient care and finances had improved but individual problems still arose — such as the discovery, inof apothecary Edward Wright in the female galleries drunk and with his clothing dishevelled. These instances, and two further financial scandals, did not directly concern the treatment of living patients and so Bethlem was exempted from legislation passed inandcontinuing to operate outside the law. After more than six centuries, the hospital was no longer independent. InBethlem was relocated to Beckenham in Kent, where it continues as a psychiatric hospital now within the London borough of Bromley.

During the years when Bethlem admitted paying visitors, some of its patients achieved minor celebrity status in London.

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A ban on visitors in the s meant that the faces and names of so-called Bedlamites were unfamiliar to the public, but this did not mean that the hospital was devoid of celebrity inmates. Periodically, well-known people would be admitted to the wards, leading to tongue-wagging among the populace. In August the hospital admitted a bona fide Georgian celebrity, the so-called sexual impostor Hannah Snell. Earlier in the century she had adopted a male persona, ed the army and fought for several years in India.

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Owning and running a private madhouse required no licence, qualifications or duty of care, a situation that led to several high-profile scandals as husbands and relatives attempted to lock away inconvenient but otherwise sane relations. Infor example, a Mrs Hawley was kidnapped by her mother and husband, and admitted to a Chelsea madhouse.

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They wished to have her declared insane in order to gain power of attorney over her finances. Once in the madhouse, Mrs Hawley was assaulted and kept secretly hidden until friends found and eventually freed her.

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Concern over false imprisonment and abuse led to a inquiry by a Select Committee of the House of Commons, but a subsequent attempt at legislation was blocked. It was not until that the first Madhouse Act was passed, requiring private asylums to be d and inspected — although, at the behest of its governors, Bethlem was exempted. Exclusion from this was a probable contributory factor to the poor conditions discovered at the hospital in It also presented the serious risk of injury or even death. What treatments were adminstered at Bedlam?

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In those parts that were habitable, MPs found small, fetid cells populated by several people chained to walls or beds. A much-improved ward in Bethlehem c More on: United Kingdom.