From Bethlehem to Bedlam - England's First Mental Institution

The origins of Bethlem Hospital

In the 13th century, Simon FitzMary rose from modest origins to become the Sheriff of London - twice. He was said to have had a veneration for the Virgin Mary and the Star of Bethlehem, which developed during his time in the crusades. When he became a wealthy political figure, FitzMary donated a piece of land in the Bishopsgate ward of the City of London to the Bishop of Bethlehem for the creation of a charitable hospital.

In 1247 the Priory of St Mary of Bethlehem was founded, devoted to healing sick paupers. The small establishment became known as Bethlehem Hospital. Londoners later abbreviated this to 'Bethlem' and often pronounced it 'Bedlam'.

The layout of the hospital

Built on the site that's now covered by Liverpool Street station in the City of London, the hospital consisted of a single storey and was compact, covering just two acres.

Centred around a courtyard with a chapel in the middle, it had approximately 12 'cells' for patients, a kitchen, staff accommodation and an exercise yard. It was to remain on this site for over 400 years until 1676 when it moved to Moorfields, also in the City of London.

Specialising in mental illness

At some point, the monks began to accept patients who had symptoms of mental illness rather than physical disability or disease. There is a claim that the residents of a building called the Stone House at Charing Cross were transferred to the Bethlem in the 1370s. It is certainly true that by 1403, 'lunatic' patients formed the majority of the Bethlem's clients - and so England's first, and perhaps most infamous, mental institution was born.

In 1346, as the hospital struggled to survive, the City of London agreed to take it over. Its subsequent specialisation in 'madness' gave it a future, although we know that its patients also included people with learning disabilities, 'falling sickness' (epilepsy) and dementia.

The hospital regime

Those who became patients were usually the poor and marginalised - sometimes believed to be dangerous - who lacked friends or family to support them.

The hospital regime was a mixture of punishment and religious devotion - chains, manacles, locks and stocks appear in the hospital inventory from this time. The shock of corporal punishment was believed to cure some conditions, while isolation was thought to help a person 'come to their senses'. At the same time, it was a religious duty to care for and feel compassionate for people afflicted by madness.

The image of 'Bedlam'

The Bethlem has long been associated with scandal and abuse in the public mind - although this was in fact intermittent rather than a permanent feature. It began in 1403 when the hospital treasurer, Peter Taverner (known as Peter the Porter), was found guilty of embezzlement and theft of hospital property.

While the vast majority of mentally ill people remained outside institutions in this period and for the next 400 years, the idea of the specialist long-term institution had been born. The image of what such an institution stood for - the infamous 'Bedlam' - had now been planted in the English imagination.

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