Read Along:
It is a holiday morning in London. Easter week, sometime in the early seventeen hundreds. The streets around Moorfields are full of people in their good clothes, and they are all walking toward the same building.
And what a building. Almost six hundred feet of pale stone. Columns. A cupola. It looks like a palace. It was built to look like a palace.
You pay your penny at the gate. A heavy door swings open. And before your eyes adjust to the dark, the smell reaches you first. Wet straw. Unwashed bodies. The sour edge of an open drain.
Then the sound. Chains dragging across stone. A door struck over and over from the inside. Someone laughing. Someone screaming. Someone singing a song with no tune.
You have not come here to help. You have come to look. And on the other side of the bars, the people you came to look at look back at you.
This is Bethlem. The first place in England built to hold the mad. For most of its long life, the rest of us knew it by a shorter name. Bedlam.
Bedlam is a word we still use. We use it for chaos, for noise, for a room that has come apart at the seams. We say a place is bedlam, and everyone knows what we mean.
The word comes from a real building. From four of them, in fact, across nearly seven hundred years. Bethlehem. Bethlem. Bedlam. The same institution, wearing different stone.
This is not a story about monsters. That is the first thing to understand. There is no single villain here. No one man with a whip. The horror of Bedlam is quieter than that, and worse. It is the horror of a system. A society that decided what to do with the people it could not understand, and then did it, for centuries, in plain sight, and called it care.
We are going to walk through the buildings. We are going to meet the people who paid to watch, and the people they watched. We are going to look at what passed for medicine. And we are going to meet two men in particular, both of them locked away, one of them entirely sane on the day they put him in irons.
And we are going to end on the moment someone finally walked in, and looked, and refused to look away.
This is the story of Bedlam. Life inside the asylum.
It begins as an act of charity. In 1247, a man named Simon FitzMary gives a parcel of land in Bishopsgate to found a priory. The Priory of Saint Mary of Bethlehem. Its purpose is to collect alms, to raise money for the Church in the Holy Land. It is a holy place. A good place.
It is not built to hold anyone.
But somewhere over the next century and a half, something shifts. The first hard record comes in 1403. A royal inspector visits and writes down what he finds. Six men, described in the Latin of the time as mente capti. Taken in the mind. And alongside them, an inventory of the building’s contents. Four pairs of manacles. Eleven chains. Six locks. Two pairs of stocks.
We do not know for certain that the irons were for the men. The record does not say. But it is a strange thing to keep in a house of God. And it is the first time we can see, in writing, what Bethlehem is quietly becoming.
By the middle of that century the place already has a reputation. A Lord Mayor of London named William Gregory described it, around 1450, in language we can barely read now.
“A Church of Our Lady that is named Bedlam. And in that place be found many men that be fallen out of their wit. And full honestly they be kept in that place; and some be restored onto their wit and health again. And some be abiding therein for ever, for they be fallen so much out of themselves that it is incurable unto man.”
Some be abiding therein for ever. Even five hundred years ago, you can hear the shape of the thing. People went in. Some came out. And some never did.
By the end of the sixteenth century the building is falling apart. In 1598, the governors send inspectors to assess the state of it. Their report survives. This is how they describe the keeper’s own quarters.
“it is not fitt for anye man to dwell in wch was left by the Keeper for that it is so loathsomly filthely kept not fit for any man to come into the house.”
Not fit for any man to come into the house. That is the inspectors describing the staff lodging. The part someone was supposed to keep presentable. You can imagine the rest.
The building sat over a sewer that blocked again and again, and waste backed up at the entrance. Inside, the patients were kept on straw, like animals, because that is how the age understood them. Dirty. Dangerous. Less than human.
A writer named Donald Lupton, in the 1630s, tried to set down the sound of the place in a single breathless line.
“Cryings, screechings, roarings, brawlings, shaking of chaines, swearings, frettings, chaffings.”
Cryings, screechings, roarings. That is a man reaching for enough words to hold the noise, and running out of them.
And then, in 1676, Bedlam gets a new home. This is where the story turns strange.
London had just burned. The Great Fire was ten years gone, and the city was rebuilding itself in stone and ambition. The governors of Bethlem wanted a building to match the mood. So they hired Robert Hooke. A brilliant man. Surveyor, scientist, one of the great minds of the age. And he gave them a palace.
Almost six hundred feet of it. A grand front of columns and a cupola, modeled, people said, on the Tuileries, the home of the French king. Two long galleries. Cells along the sides. And at the gates, two enormous figures carved in Portland stone. One slumped in despair. One writhing against his chains. Melancholy, and Raving Madness. They were the first thing you saw. They told you exactly where you were.
A visitor named Ned Ward came through in 1699 and wrote about it in a book called The London Spy. When he first saw the building, he could not believe what it was for.
“We came in sight of a noble pile of building... I conceiv’d it to be my Lord Mayors Palace, for I could not imagine so stately a structure could be design’d for any quality inferior.”
He thought it was the mayor’s house. A palace for the most important man in London. Then his friend told him the truth, and Ward had a darker thought.
“I think they were mad that built so costly a colledge for such a crack-brain’d society.”
Another visitor, the satirist Thomas Brown, put the same unease more sharply. He wondered aloud which of them was truly out of their wits.
“whether the persons that ordered the building of it, or those that inhabit it, are the maddest.”
Here is the thing about the palace. It was a lie. The grand front was built on rubble, without proper foundations, and it began to crack almost at once. The walls leaked when it rained. The beautiful facade was for the street, for the donors, for the visitors. Behind it, the cells were cold, the roof failed, and the rats came in.
The galleries ran the length of the building. More than a thousand feet of corridor, end to end, thirteen feet high, stone underfoot. Every sound multiplied and traveled. A man in one cell could hear every other man, in every other cell, all day and all night, the noise rolling down the gallery and back again.
The building was exactly like the institution it housed. Magnificent from the outside. Rotting within.
By the early nineteenth century the palace had sagged into the marsh it was built on, and Bedlam moved a third time. To St George’s Fields, in Southwark. A new building, by an architect named James Lewis. Three storeys. Long ranges of cells, each one eleven feet by seven and a half.
It looked more like what we would now call a hospital. But the cruelty had only changed its shape. The windows on the upper floors were left without glass. On purpose. The idea was to vent what one official called the disagreeable effluvias peculiar to all madhouses. The smell, in other words. They would rather the patients froze than the corridors stank. And in winter, the patients froze.
Three buildings. A holy house that became a prison. A palace that was really a ruin. A hospital that left the windows open in January. And running through all of it, one constant. The building was never truly designed around the patient. It was designed around the visitor.
Because for most of Bedlam’s history, the public was not merely allowed in. The public was the point.
Before we dive in further, please allow me a moment of self-promotion.
If what unsettles you about Bedlam is not the chains but the bureaucracy behind them, the ledgers, the locked doors, the quiet decision to make a person disappear, then I have written something for you.
It is called The Defixio. A Roman fort on the cold edge of the empire. A physician who lifts a flagstone in the hospital floor and finds a child’s skull packed in lime. And a garrison that would rather bury the truth, and him, than let the record speak.
It is a story about the same thing this episode is about. What an institution chooses to forget, and the one person who refuses to.
New installments are going up now. You will find the link in the show notes. Come and read it with me.
Now. Back to London.
Back to the gates. Back to the penny, and the crowd.
For the better part of two centuries you could visit Bedlam the way you might visit the lions at the Tower. It was a day out. The first solid record of a paying visitor is from 1610, a nobleman named Lord Percy. By the 1680s the governors are noting the great quantity of persons that come daily to see the lunatics. And they noticed something else. The visitors left donations. The spectacle made money.
A Swiss traveler named Cesar de Saussure toured London in 1725 and wrote down what it was like to walk the wards.
“you find yourself in a long and wide gallery, on either side of which are a large number of little cells where lunatics of every description are shut up... On holidays numerous persons of both sexes, but belonging generally to the lower classes, visit this hospital and amuse themselves watching these unfortunate wretches, who often give them cause for laughter.”
Who often give them cause for laughter. Read that again. People went to Bedlam to laugh.
On a busy holiday, a hundred visitors or more would file through in a single week. They brought their children. They prodded the patients to get a reaction. Some brought drink. In its better years the hospital collected three hundred pounds and more from this traffic. Human suffering, monetized, one penny at a time.
If you want to see how ordinary this was, look at William Hogarth. In 1735 he finished a series of paintings called A Rake’s Progress, the story of a young man’s ruin. The final image is set in Bedlam. The rake lies dying on the floor, half naked, mad. And behind him, two fashionable women have come to tour the madhouse. They are laughing behind their fans. Hogarth did not invent that detail. He was painting what everyone had seen.
And the fascination did not stay inside the walls. Out in the country a particular kind of beggar appeared. The Abraham men. They claimed to be harmless lunatics, discharged from Bedlam and turned loose, and they played the part. Some faked the marks of confinement on their arms, scoring the skin with burnt paper, gunpowder, and urine, to look as though they had worn the irons. They wore ribbons and fox tails, carried long sticks, and begged on the strength of the name. Bedlam had become so notorious that people pretended to have been inside it.
Shakespeare knew the type. Poor Tom, Tom o’ Bedlam, the wandering madman, was a stock figure on the stage. The asylum had escaped the building and entered the language, the theater, the imagination of a whole country, long before anyone thought to ask what it was actually like in there.
So that was the public face. Madness as theater. But the visitors only ever saw the galleries. They did not see what was done to the patients in the name of curing them. And that, if anything, was worse.
The medicine of the age believed that madness was a disease of the body. An imbalance of the four humors, the old idea handed down from Galen, fifteen hundred years before. Too much black bile. Too much blood. And the cure for an excess was simple. You took it out.
So they bled them. They blistered the skin with caustic paste and let it weep. They gave them drugs to force vomiting, and drugs to empty the bowels, and they did it again, and again, by the calendar. Every spring, like clockwork, the whole hospital was purged. Bled and blistered and emptied, whether they needed it or not.
A man named Alexander Cruden, who had been confined himself, described the genius of the Bedlam physician with total contempt.
“The common prescriptions of a Bethlemitical Doctor are a purge and a vomit, and a vomit and a purge over again, and sometimes a bleeding, which is no great mystery.”
No great mystery. And the men prescribing it were certain of themselves. For over a century, Bedlam was run by a single family of physicians. The Monros. Four generations, more than a hundred years, father to son. John Monro, who held the post for forty years, wrote that the best and most reliable cure was, in his word, evacuation. He said he had never seen, and never heard of, the bad effect of vomits.
Never heard of a bad effect. Of forcing a sick and frightened person to vomit, for hours, for days, by the season. He simply was not looking.
And when bleeding and purging were not enough, there were the machines. There was a rotational chair, a device that spun the patient round and round, forty turns at a time, an hour at a stretch, until they were sick and dizzy and could not stand. It was sold as therapy. It worked just as well as punishment, and was often used as both.
And there was the water. Cold water, by the bath, the patient held under for long stretches. Or wrapped in towels soaked in ice. Or struck with it without warning. The shock, they believed, would jolt the mind back into its proper place. It did not. It only made a cold, wet, terrified person colder.
There was even a contraption the keepers called the bath of surprise. A floor that gave way without warning and dropped the patient into cold water beneath. The shock was the entire point. And if a patient refused to eat, they were fed by force. A spoon forced past the teeth. Later, a tube down the throat, or a pump. Fear, dressed up as physick.
And then, in 1770, the doors were closed to the casual public. To get inside now you needed a ticket signed by a governor. It sounds like mercy. It was not. With the crowds gone, so was the only outside eye on the place. For the next forty years Bedlam ran unobserved and unregulated. No witnesses. And what happens to the vulnerable when no one is watching is its own kind of answer.
By the turn of the century the hospital was dilapidated and starved of money. The surgeon, a man named Bryan Crowther, was by one account generally insane and mostly drunk. The physician barely came at all. To be sent to Bedlam, one historian has written, was not only a matter of shame. It carried a real risk of injury, or of death.
It is easy, at this distance, to let these become numbers. A regime. A system. So let me do the thing the visitors never did. Let me stop at one cell, and tell you about the person inside it.
In January of 1797, a man named James Tilly Matthews was admitted to Bedlam. He had been a tea broker. He had been to Paris during the Revolution, mixed up in some doomed attempt at peace between Britain and France, and he had come home convinced of something extraordinary.
He believed there was a machine. A gang of seven people operated it, he said, from a cellar near London Wall. They were masters of what he called pneumatic chemistry. And their machine, which he named the Air Loom, could reach across the whole city and into his body.
The hospital apothecary, a man named John Haslam, wrote the whole thing down, and in 1810 he published it. It is one of the first detailed accounts we have of what we would now call paranoid schizophrenia. And the detail is staggering.
Matthews had a name for everything the Air Loom did to him. Fluid locking, which sealed the root of his tongue so he could not speak. Lobster cracking, a crushing pressure that squeezed the breath from his chest. Kiteing, where the gang would lift a single idea into his brain and pin it there, hovering, for hours, so that he could think of nothing else. Lengthening of the brain. Stomach skinning. Cutting the soul from the sense.
And the gang had names too. Bill the King. Jack the Schoolmaster, who kept the records. Sir Archy, who told obscene jokes. The Glove Woman, who worked the machine in cotton mittens and never spoke.
Here is what stays with me. Matthews drew the Air Loom. He described its workings with the precision of an engineer. From inside his illness, he had built a complete and consistent world. A machine to explain the unbearable feeling that something outside himself was reaching in and taking him apart.
Two outside doctors examined him and declared him sane. The hospital said otherwise, and kept him. We are still arguing, two centuries later, about who was right.
Bedlam held the forgotten. But it also held the infamous. If you had walked the galleries in the right years, you would have passed faces the whole country knew.
There was Margaret Nicholson. In 1786 she approached King George the Third at the gate of St James’s Palace, a petition in one hand and a dessert knife in the other, and tried to stab him. The blade was thin and turned on his coat. The King was unhurt, and what he said was, take care of this poor woman, do not hurt her. She was judged insane and sent to Bedlam without a trial. She spent her first year there in chains. She stayed until she died, more than forty years later, reportedly the oldest patient in the house.
There was Jonathan Martin, who believed God spoke to him in his dreams. In 1829 he hid himself inside York Minster after evening prayers and set it alight, and stood and watched one of the great cathedrals of England burn. He was found not guilty by reason of insanity, over his own furious objection, and sent to Bedlam, where he went on drawing his visions until the day he died.
And there was Richard Dadd. A gifted young painter, traveling the world, until something came apart in him and he became convinced that his own father was the devil. In 1843 he killed him. He spent the rest of his life, more than forty years, confined as a criminal lunatic. And inside those walls, he painted. Tiny, jeweled, obsessive canvases. The most famous of them, a thing called The Fairy Feller’s Master-Stroke, worked over for years, every blade of grass rendered in miniature. Some of the strangest and most beautiful art of the century came out of a cell in Bedlam.
Matthews, at least, was understood to be ill, even if the treatment was useless. The next man was not granted even that.
His name was James Norris. Some records call him William. He was an American sailor, and he came into Bedlam around 1800. He was difficult. He had hurt people. And so, in 1804, the keepers solved the problem of James Norris permanently.
They built him a harness.
I am going to describe it, because the description is the horror, and it survives in the official record, word for word. A stout iron ring around his neck. From it, a short chain running to a ring that slid up and down an upright iron bar, more than six feet tall, fixed into the wall. Around his body, an iron bar riveted shut. From that bar, projections that enclosed each arm and pinned them to his sides. More bars over the shoulders, riveted front and back. He could not raise his arms. He could not walk more than a step from the wall. He could not lie on his side.
He stayed in that harness for more than a decade.
And here is the part that turns the stomach. James Norris was not raving. He read. Constantly. History, biography, anything the keepers would bring him. He read the newspaper every day and followed the war against Napoleon closely, and he could discuss it, coherently, with anyone who stopped at his cell. He kept a cat.
For years, a clear-minded man lay chained to a wall by the neck, reading the news, stroking a cat, going nowhere. The world did not know he existed.
Until 1814, when somebody walked in.
The man who walked in was named Edward Wakefield. A philanthropist, a Quaker by temperament, part of a small circle who had begun to suspect that England’s madhouses were hiding something. In 1814, he went into Bedlam to see for himself.
He found Norris in his harness. He found the women’s wing. And he wrote it all down for a committee of Parliament. About one side room, he wrote this.
“one of the side rooms contained about ten patients, each chained by one arm or leg to the wall... The nakedness of each patient was covered by a blanket-gown only... the feet even were naked.”
And the men’s room was the same.
“six patients were chained close to the wall, five handcuffed... all were naked, except as to the blanket gown or a small rug on the shoulders, and without shoes; one complained much of the coldness of his feet; one of us felt them, they were very cold.”
One of us felt them. They were very cold. A grown man, chained naked to a wall, complaining that his feet were cold, and a visitor reaching down to check, and finding that yes, they were. Wakefield said he could hardly imagine a human being in a more degraded condition. The room, he said, had the complete appearance of a dog kennel.
Wakefield brought an artist to record Norris in his irons. The engraving was printed, laid before Parliament, and sold in the street. And a public that had spent a hundred years laughing at Bedlam finally saw it. Norris was taken out of the harness not long after. He died within months. His body had nothing left.
But the picture did its work.
In 1815, a parliamentary committee opened an inquiry into the madhouses of England. The testimony was damning. The member who brought the report to the Commons, a man named Rose, did not soften it.
“In no country were there any set of people so unprotected as the unhappy persons to whom the Report referred. The way in which they were usually confined, was that of criminals; and their treatment was in general worse than the ordinary treatment in gaols.”
Worse than the treatment of criminals. Said out loud, on the floor of Parliament, about people whose only crime was to have lost their minds. Too few keepers, and the few too cruel. And when it was over, the men who had run Bedlam were finished.
John Haslam, the apothecary who had so carefully documented Matthews and his Air Loom, was dismissed. He lost nearly everything, and had to sell his library to survive. Thomas Monro, the last of the dynasty that had ruled the place for a century, lost his post. He was denounced, in the language of the day, as wanting in humanity.
Wanting in humanity. That was the official verdict on a physician who had inherited the care of the mad as a family business, and who, by the end, barely visited the wards at all.
And slowly, the thing began to change. It had actually started years earlier, and not in London. In 1796, in York, a Quaker named William Tuke opened something he called the Retreat. It rested on a single radical idea. That the humanity of a person, the inner light, as the Quakers put it, could never be fully extinguished. No chains. No manacles. No beatings. They gave the patients gardens, and work, and kindness, and were astonished by how many of them recovered.
And in 1839, at a vast asylum in Hanwell, a physician named John Conolly took the next step. He swept the mechanical restraints away entirely. No harnesses. No irons. In a great institution, against fierce opposition, he simply took the chains off. Within little more than a decade, the care of the mad in England had been remade.
As for Bedlam itself, it is still here. It never closed. It moved one final time, out to Beckenham in south London, where it remains a working psychiatric hospital, one of the oldest in the world. And in 2015, on its grounds, a museum opened. The Bethlem Museum of the Mind.
The two stone figures from the old gate, Melancholy and Raving Madness, sit inside it now. You can stand in front of them. The same faces that greeted the patients three hundred years ago.
We started with a word. Bedlam. Chaos, noise, a place that has come apart.
I think about the people who used that word so easily, in the centuries when the real place was still running. The ones who paid their penny on a holiday, walked the galleries, laughed, went home, and at supper described the day out at Bedlam. They were certain the madness was on the other side of the bars.
But look at what they built. A palace with a rotting interior, raised to hide what it held. A medicine that tortured the sick and called it a cure. A man left lucid and chained to a wall for ten years while the city walked past his door. The patients did not make Bedlam. We did. Sane men, with good intentions and account books, one reasonable decision at a time.
So here is the question I cannot put down. Not whether they were cruel. They were. The question is whether they knew. Whether you can build a thing like Bedlam by accident, looking the other way, telling yourself the whole time that it is care. And whether, somewhere right now, we are doing it still, and calling it by a kinder name.
I’m A.M. Blackmere. Thank you for listening.
