Bedlam: The Asylum and Beyond

Bedlam: The Asylum and Beyond was a four-month-long exhibition and series of programs at the Wellcome Collection in London and associated art galleries (September 15, 2016, to January 15, 2017). The centerpiece was a multi-room exhibition tracing the history of Bethlehem Royal Hospital and of ideas of madness—often associated with the nickname of the hospital: "bedlam."

In the eighteenth century the hospital was a madhouse, where the mentally ill were cared for and separated from other groups judged to need social support and segregation. They lived in a grand building designed by the scientist and polymath Robert Hooke, which conveyed the humanitarian sentiment that the mad were not to blame for their condition. Inside, however, patients lived in the chaotic conditions portrayed by William Hogarth in the final scene in his series of etchings The Rake's Progress (on display in the exhibit).

In the nineteenth century, ideas about mental illness changed, and Bethlehem became more of an asylum, where principles of moral treatment (a form of milieu therapy) were implemented. Part of patient treatment was their entertainment and resocialization by evening slide shows, dances, and classes in art and music. The twentieth century ushered in the "mental hospital," and in 1930 a new Bethlehem hospital opened in a more rural setting, with patients living in cottages, taking classes, and recreating in the grounds. Physicians, in turn, enjoyed the latest trappings of scientific psychiatry, drawing their authority from modern laboratories, equipment, and medications.

To show three centuries of changing treatments and concepts of mental suffering, the Bedlam exhibition deployed an admirably diverse range of media: architectural plans, photographs, etchings, correspondence, art, legislative reports, and medical records. In keeping with a twenty-first-century emphasis on patients' perspective and experiences, items on display included patient art (e.g., a haunting, full-length portrait of the superintendent), an architectural plan for a new Bethlehem by a talented patient, and objects like embroidered petitions to Queen Victoria from a woman who had been committed for many years. The richness of these objects and images can be seen in an accompanying book, This Way Madness Lies: The Asylum and Beyond by Mike Jay, co-curator of the exhibition.

A central theme of book and exhibition is that the history of mental illness and its treatment is cyclical. Rather than a march toward scientific truth, one sees "cycles of abandonment, reform, forgetfulness, neglect and further reform" (p. 12). Today, for example, the asylum is replaced by a marketplace of often faddish treatments for mental problems, reminiscent of those catalogued in Robert Burton's The Anatomy of Melancholy (1621).

A notable feature of the exhibition is its emphasis on life "Beyond the Asylum"—beyond traditional institutions and medical perspectives on mental illness. Visitors to the exhibition learned of this through an audio companion of patient narratives (https://wellcomecollection.org/ourvoices), a play inspired by the Hearing Voices movement, patient-curated discussions, and programs focusing on patient art, letters, and poetry, held at the Bethlehem Museum of the Mind in the London suburb of Beckenham. Finally, the group Madlove invited attendees to envision alternatives to the asylum and contribute to a re-imagined "safe place to go mad" (p. 248).

Historians of psychiatry and social historians of medicine will be sorry if they missed this exhibit but should greatly enjoy the accompanying book. It is beautifully produced and is full of stunning images and useful text illustrating historical themes, events, and trends. Many of the images are familiar, but plenty will be new to even those well versed in the history of madness.