From Bethlehem to Bedlam - England's First Mental Institution

This section explains the origins of the 'Bethlem', England's first hospital for the mentally ill. With its somewhat scandalous history it came to represent all institutions of its kind in the public imagination.

Map showing location of Bethlem in Bishopgate – drawn by Anthonis van den Wyngaerde 1558 engraved by Franciscus Hogenberg 1559

Map showing location of Bethlem in Bishopgate – drawn by Anthonis van den Wyngerrade 1558 engraved by Franciscus Hogenberg 1559
© Museum of London

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'.

Construction work in the extension to Liverpool Street Station by the Great Eastern Railway, 1894 on the foundations of the first Bethlem Hospital.

Construction work in the extension to Liverpool Street Station by the Great Eastern Railway, 1894 on the foundations of the first Bethlem Hospital.
© English Heritage

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.

The Hospital of Bethlem [Bedlam] at Moorfields, London: seen from the north, with ladies and gentlemen walking in the foreground, one giving money to a cripple. Engraving by W. H. Toms.

The Hospital of Bethlem [Bedlam] at Moorfields, London: seen from the north, with ladies and gentlemen walking in the foreground, one giving money to a cripple. Engraving by W. H. Toms.
© Wellcome Library, 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.

Plaque on the original site of Bethlem Royal Hospital  with kind permission from The Bethlem Art and History Collections Trust

Plaque on the original site of Bethlem Royal Hospital with kind permission from The Bethlem Art and History Collections Trust

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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