Madness in Clerkenwell

Bedlam became a byword for chaos and cruelty – as well as, shockingly, a popular tourist destination. Andre Paine looks at the controversial history and cultural impact of Clerkenwell’s mental hospital.

Bedlam. It’s a word that conjures up hellish images of the violently insane. The Bethlem Royal Hospital – also known as the Bethlehem Royal Hospital and more popularly just as “Bedlam” – was a magnificent 18th century landmark in Clerkenwell. The country’s first mental institution, founded in 1247, Bethlem was originally in Bishopsgate. Back then, violent patients would be ducked or whipped. It was the start of treatments that later resulted in scandal. The situation for inmates improved somewhat when the hospital was rebuilt at Moorfields, on the edge of Clerkenwell, in 1675.

The polymath Robert Hooke designed a grand building that became symbolic of London’s reinvention after the Great Fire. Two striking stone sculptures of men ravaged by insanity, Raving and Melancholy Madness, were set above the gates. But for all the baroque splendour, it was hardly a humane regime. The cells were gloomy, attendants were overworked and the treatments – bleedings, cold baths and purging with emetics – were more like punishments. 

Behind the facade, the hospital was also poorly constructed. It was built on wasteground, without foundations; before long, the walls developed cracks and the roof leaked. “The outside is a perfect mockery to the inside,” said satirist Thomas Brown, who wondered “whether the persons that ordered the building of it, or those that inhabit it, were the maddest?”

The Moorfields site became the archetypal “madhouse” at a time when madness was the subject of numerous poems, plays and artworks. Shakespeare’s tragedies had already focused on mental health and during the 17th century the insane asylum loomed large in popular culture and became a secular vision of hell. People were soon able to witness the goings on for themselves. Financial pressure resulted in the governors opening up the asylum to the public. The visits raised several hundred pounds a year, as well as providing a moral and educational experience. James Boswell recorded a day trip in his journal, while local man Samuel Pepys sent his family along.

However, while some visitors were relatives wanting to offer comfort, many went simply for the freak show. Patients were chained in cells like caged animals in a zoo while onlookers boisterously mocked and jeered. “The world has become a great Bedlam, where those who are more mad lock up those who are less,” wrote 17th century health campaigner Thomas Tryon. The institution also lent itself to satire about the moral state of the nation.

In the final scene of Clerkenwell-born William Hogarth’s A Rake’s Progress (1732-33), Tom Rakewell ends up insane and destitute in Bedlam. Public attitudes to mental illness gradually changed, however, not least because of one of the most famous cases of madness: George III. William Battie, one of Bethlem’s governors, established the nearby St Luke’s hospital and implemented more therapeutic treatments.

Public visits ended in 1770, replaced by a strict ticketing system overseen by the governors. But while Bedlam became less visible, the problems continued. The building was crumbling and vermin-infested, while troublesome inmates were secured in straitjackets or shackles. With a plan to move to Lambeth (where the Imperial War Museum is today) in 1815, the Moorfields site closed, amid scandal following a parliamentary investigation led by Quaker philanthropist Edward Wakefield. Underfunded and understaffed, the hospital was decreed a place of cruelty and neglect.

As a result, the chief physician, Thomas Monro, resigned. He had given a free hand to employees like surgeon Bryan Crowther, who was more interested in grisly experiments than assisting the mentally ill. Ironically, Crowther, an alcoholic, was himself insane by the time he died – also in 1815. Conditions for patients improved once more and, in 1930, the hospital moved to Beckenham in Kent, where it still operates today, 770 years after its foundation. The Clerkenwell connection also continues, with the famous figures of Raving and Melancholy Madness still on display – not on the gates, though, but as part of the hospital’s own museum marking its history.