Dissertation

1
REBECCA NIMMO
History and English (BA Hons) QV31

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What was the public image of Bethlem Hospital
from 1750 – 1800?
by
Rebecca Nimmo
History and English (BA Hons) QV31

3
Abstract
This study seeks to discover eighteenth century influences and how they contributed to the public image
of the most famous lunatic asylum, Bethlehem Hospital. It covers a time period often ignored in relation
to medical history in comparison to the institutionalisation of madness and the advancement of treatments
in mental illnesses discovered in the nineteenth century.
“Bedlam”, the hospitals nickname has always carried a definition of horror and poor conditions for
patients in the hospital, from which artists have demonised Bethlem for entertainment or political
purposes. This version of Bethlem’s history has been regurgitated over and over in historical literature.
What has not been explored is the public image this created of Bethlem Hospital to an eighteenth century
audience. Current literature doesn’t seek to find positive perceptions of Bethlem Hospital or acknowledge
there ever was any. Through the examination of the cultural environment of 1750-1800 media, gossip,
discourse, art, science,mad-doctors, politics and religion are assessed to give a more balanced account of
how Bethlem has been perceived in history.

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Contents
Introduction 5
Chapter 1 Media, Gossip and Discourse 10
Chapter 2 The impact of Art 17
Chapter 3 Political Influences 25
Chapter 4 Science and Mad-doctoring 33
Chapter 5 Religion and Madness 39
Conclusion 44
Bibliography 45

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Introduction
Opened in 1247 by Simon Mary Fitzgerald, the Hospital now known as Bethlem or Bedlam
(neither of which being its original title), was a Piory “of the order of St Mary of Bethlehem.” It
became a place to house and heal the sick from the fifteenth century when it is recorded there
were six insane patients in Bethlem in 14031. Bethlem was rebuilt at Moorfields in 1676 and
designed by Robert Hooke to look like the Tuileries Palace in Paris2 (which offended Louis XIV
as it was his royal palace3) .It was the first public asylum in the world and a prominent part of
popular consciousness especially during the eighteenth and nineteenth centuries with the rise of
men choosing medical careers4. With such a vast history, public opinion of Bethlem has differed
throughout the centuries based on the cultural environment. Therefore the influences of media,
art, politics, science and religion in the eighteenth century have been examined respectively in
their chapters in relation to Bethlem.
The study gives perspective to contemporary historiography and gossip of Bethlem’s public
image as an evil institution5. Most of the literature found on madness focuses on the nineteenth
1 Catherine Arnold, Bethlem and its Mad, (London: Simon and Schuster, 2008)
2 Christine Stevenson,“Robert Hooke’s Bethlem”, Journal of the Society of Architectural Historians 55, No. 3,
(1996): pp. 254- 275
3
ibid
4
Andrew Scull et al, Masters of Bedlam. ,(Princeton University Press, 1996)
5
Patricia Allderidge,“Bedlam: Fact or Fantasy”,in The Anatomy of Madness: Essays in the History of Psychiatry,
Volume 2, edited by W.F.Bynum, Roy Porter, Michael Shephard. London; Routledge, 2004, 17-32

6
century when in 1815 Bethlem was investigated for its patient brutality6 and have come to focus
their condemnations of this cruelty on Bethlem, despite the fact other asylums such as the York
Retreat, (supposedly a symbol of “moral management”7), were castigated for the same
insensibility to the insane8. Patricia Allderidge, Bethlem’s official archivist, goes as far to say
that “I have come to the conclusion that, on a whole, historians of psychiatry actually do not
want to know about Bethlem as a historical fact because Bethlem as a reach-me-down cliché is
far more useful”9. Therefore the study uncovers some alternative perceptions of Bethlem as an
important and positive institution.
Chapter one uses local London newspapers to establish the middle and upper class views of
Bethlem in the media. Recurrent failures of the institution are regularly reported but against the
backdrop of so many donations to the charity its negative public image is overshadowed.
However, it is not unlikely that as Michel Foucault argues Bethlem was viewed as a hospital for
“the containment of the irrational”10. In the seventeenth century there was a prevalence of
madness in the streets as it was the duty of the family to look after their insane, which often they
did not. The increasing popularity of confining the mad to Bethlem therefore may have been as a
result of the new cultural environment of the Age of Reason. Nevertheless the newspaper articles
and theses written on Bethlem do not portray a want to “avoid scandal11” by confining madmen
6
ibid
7
Roy Porter,Faber Book of Madness. (London:Faber and Faber, 1991)
8
Jonathon Andrews et al, The History of Bethlem. (London: Routledge, 2013)
9
Patricia Allderidge,“Bedlam: Fact or Fantasy”,in The Anatomy of Madness: Essays in the History of Psychiatry,
Volume 2,
10
Michel Foucault, Madness and Civilisation, Trans Richard Howard. (London: Routledge, 2001)
11
ibid

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but offer a compassionate analysis of their situation and a genuine want to support Bethlem as an
institution.
The gossip of visitors found in letters, newspapers and personal accounts to Bethlem however do
portray what Foucault notes as elevating madness to spectacle, for which Bethlem was turning
madness into “a public scandal for general delight”12. But many of these primary sources were
written with a view to entertain their readers and there remain reformers from 1750 onwards who
were calling for the abolition of this practice and visitors who were disheartened at the patients in
Bethlem rather than excited. Therefore media, discourse and gossip display a mixed perception
of Bethlem as the upper classes supported the institution, the medical community called to
reform the institution and the lower classes were necessitous of such an asylum.
Chapter Two assesses eighteenth century artistic depictions of Bethlem. Images presented in
William Hogarth and Richard Newton’s satirical etchings encourage its audience to fear the
horror of Bedlam. Nevertheless the limitations of satirical images are their inability to be taken
seriously and as a result offer more a moral message by portraying the similarities between the
sane and the mad. This art unwittingly contributed to the changing of mid-eighteenth century
attitudes towards sympathies for the plight of the insane. Porter is keen to address that art only
reflects art13, however it affects public opinion even in its inaccuracy to comply with the truth.
For example the architecture of Bethlem itself was a form of art which earned publicity and
intrigue into the charity although its purpose was to gain money through visitation and
donations14. Therefore the art of the literate and rich encouraged compassion for madmen and
12
ibid
13
Roy Porter, Mind Forg’d Manacles. (London:Penguin,1990)
14
Christine Stevenson,“Robert Hooke’s Bethlem”,

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critiqued the conditions of Bethlem giving it a less favourable public image. But in contrast the
establishment appeared grand and advertised its professional understanding of the conditions of
melancholy and mania through the statue by Cibber at the gate15, symbols for all of London to
see.
Chapter three explores how eighteenth century politics affected the public image of Bethlem,
when primary sources such as political caricatures displayed the synonymy of unfavourable
politicians and Bethlem as a symbol of madness. Bethlem Hospital registers uncover the number
of inmates perhaps illegitimately housed in Bethlem16 due to the lack of laws and controls on
asylums and the government. It may have been viewed simply as a dumping ground for
unwanted dissenters of the state. Newspapers and poems are used to uncover the public scandal
of Margaret Nicholson’s attempted regicide and how it boosted the popularity of Bethlem
Hospital’s public image. Furthermore English physician George Cheyne’s publication is used to
demonstrate how the “English Malady” divided madness into social classes, into the melancholic
pauper lunatics of Bethlem and the wealthy fashionable “hypochondriac melancholics”17 who
often remained in society.
Chapter Four examines how science and mad-doctoring affected public opinion and primarily
what men of the medical profession thought of the institution. For the first time Bethlem’s
practices were challenged and given enough publicity that Dr Monro, the famous physician,
sought to defend himself and the institution in Remarks on Battie’s Treatise. The chapter also
15
Bynum. W.F, Roy Porter and Michael Shepherd (eds) The Anatomy of Madness, Vol 1 People and ideas
(London:Tavistock, 1985)
16
Patricia Allderidge, “Criminal Insanity: Bethlem to Broadmoor”, History of Medicine 67, no.1 (1974)
17
George Cheyne, The English Malady, ( London: printed for G. Strahan, 1733)

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explores ex-patients recounts of the “trade in lunacy” and how the undercurrents of dissent began
to rise against Bethlem. Despite this John Haslam’s publication “Observations of Madness”
promoted the institution but was amongst other medical treatise that were doing exactly the same
in this period. One positive public image was of the Monro dynasty, for Bethlem had been
governed by physicians of the same family for a century18. London newspapers demonstrate how
important this was in a time when an abundance of quack doctors remained in the medical
profession and finding a trustworthy physician was problematic.
Chapter five explores religious ideas between 1750 and 1800 , most prominently the emergence
of Methodism became intertwined with ideas of madness and specifically Bedlam itself due to
the close proximity of Methodist meeting rooms by Moorfield19. Christianity had also taught
eighteenth century London how to perceive madness, often thought of as a sin but healed by
Jesus in his mercy20. The bible teaches of charity which also suggests Bethlem was viewed as a
benevolent institution to cure the mad.
Though the nineteenth century would expose the evils of Bethlem, notably of James Norris
chained to his cell for twelve years21. In the eighteenth century Bethlem physicians and
custodians were not seen as acting on their own accord as a body of evil conspiring and
18
Jonathon Andrews and Andrew Scull, Undertaker of the mind : John Monro and Mad Doctoring in Eighteenth
Century England, (California: University of California Press, 2001)
19
Misty G. Anderson, Imagining Methodismin Eighteenth-Century Britain. (Baltimore:Maryland: John Hopkins
University Press,2012)
20
Matthew4:24, “Bibles verses about Insanity”, Openbible.info, Accessed March 3 , 2014,
http://www.openbible.info/topics/insanity
21
Catherine Arnold, Bethlem and its Mad,

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experimenting in ‘treatments’ of brutality on patients22. This cruelty was a product of the cultural
environment of the eighteenth century. This is reflected by the mix of positivity and negativity
towards the public image of Bethlem 1750-1800.
Media, Gossip and Discourse
It is imperative to represent the facts and misconceptions arising from media, gossip and
discourse within Bethlem. Gossip and discourse are important mediums as they were available to
all classes including the illiterate paupers. Few primary sources have been left behind to help
uncover poor people’s public opinion on the Hospital. As for the media, they represent a public
image of Bethlem from middle and upper class perspectives.
Newspapers in London refer to one criticism of Bethlem recurrently, the discrepancies of
admitting a patient into the Hospital. The London Daily Advertiser and Literary Gazette features
a reader, J.T, who has sent a letter to “the printer” of the paper in 175123. His main point attests
to the fact Bethlem is “incapable of receiving and providing for the Relief of all unhappy
Objects24” a truth that “every Governor of that House”25 is aware. One of the crippling
consequences of Bethlem’s delays according to The London Daily Advertiser and Literary
Gazette is that in desperation the ‘lunaticks’ are sent elsewhere “into the Hands of a Persons
utterly unskilled in the Treatment of the Disorder”26. It is important to note that although the
procedure of admission into Bethlem is condemned what is taken for granted is the expertise of
Bethlem doctors who therefore are skilled in the Treatment of disorders. This was important for
23 J.T, “To the printer of the London Daily Advertiser”, London Daily Advertiser, April 6, 1751
24 ibid
25 ibid
26 ibid

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Bethlem’s public image because the eighteenth century, as will be discussed in Chapter four, was
rife with ‘quack’ doctors27. Despite the fact newsletters such as the Gazette usually did not reach
an audience outside of London,28 a similar complaint is publicized in the London Chronicle in
177729 and The General Evening Post in 175030. Overall there is a general consensus amongst
these newspapers and its readers of the inefficiency of Bethlems’ admissions. Although the tone
of them is not to discredit Bethlem entirely “[it is] a noble and extensive charity and the public
have as much Benefit as can be reasonably expected”.31 This was the opening line of The
General Evening Post before launching into its criticism, which amongst other evening posts in
London was the main source for provincial news giving it a wider circulation.
Despite the negative implications of these views there is one paper that continuously denies any
wrongdoing at Bethlem from 1750 -1800 promoting a positive public image. The London
Evening Post in retaliation reports that Bethlem is increasing its size by installing twelve new
cells for male lunaticks and twelve for females and disapproves of the “unreasonable Objections
of Delays”32. Even when London Evening Post has the opportunity to chastise Bethlem and
Bridewell Hospitals lack of medical provisions “[which] has been much neglected”33 instead it is
reported on January 31st 1751 that there are plans for an apothecary and a “proper Operator to
27 Porter, Roy, Quacks,Fakersand Charlatan in English Medicine. (London: History Press, 2003)
28 Jeremy Black, The English Press in the Eighteenth Century, (London: Routledge, 2010)
29 London Chronicle,May 22-24, 1777, Issue 3193
30 “Considerations upon the usefulness and necessity ofestablishing an hospital”, General Evening Post, November
22-24, 1750, Issue 2648
31 ibid
32 London Evening Post, March12-14, 1751, Issue 3650
33 London Evening Post, January 31- February 2, 1751, Issue 3633

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prepare the medicines”34. The newspaper once again glosses over the failure of the hospitals’
responsibilities to its patients by reporting a solution that may or may not be sufficient.
Concurrent with my findings is Andrews and Sculls’ conclusion that the Evening Post was
“Bethlem’s loyal organ in the press”35. Studies suggest the “gentry and middling society of
England, Wales and Scotland”36 read this newspaper with a “wide circulation37”. Therefore
although Londoner’s may have been more aware of the discrepancies of Bethlem through
newspapers and first-hand accounts, the wider community of Britain may have been predisposed
to side with the Evening Post’s positive public image. Jeremy Black states that “Most provincial
papers in the second quarter of the century had “opposition sympathies38” and as a result The
London Evening Post was one of the key newspapers they reprinted from39.
In the Whitehall Evening Post in 1781 Bethlem defends itself against its bad press40. The
governors of Bethlem present a statement in 1781 praising itself and the “munificence and
liberality of the donors”41. As Bethlems’ revenue relied on benefactors,42 its reputation as a
34 ibid
35 Jonathon Andrews and Andrew Scull, Undertaker of the mind : John Monro and Mad Doctoring in Eighteenth
Century England, (California: University of California Press, 2001)
36 “The London Evening Post and Mid-Eighteenth Century British Politics”, English Historical Review 439 ,
(1995): 1132-1156
37 ibid
38 Jeremy Black, The English Press in the Eighteenth Century, London: Routledge, 2010
39 ibid
40 Governors of Bethlem Hospital, “Grand Committee, Bridewell and Bethlem Hospitals”, Whitehall Evening Post,
April 19, 1781 - April 21, 1781; Issue 5464
41 ibid

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worthy charity was evident in its continuity as a functional Hospital. Occasionally as in 1784, the
hospital “by some late Benefactions”43, could expand its capacity for “one hundred incurables44”.
This article, by steward Henry White, states there are “generally upon the list more than Two
Hundred Dangerous Lunatics”45 once again proving that Bethlem was in high demand. Moreover
people were more than willing or desperate to house the mad in Bethlem therefore it had a public
image of being necessary.
Often people tended to donate fifty pounds and specified that it went to the care of the
incurables46 which demonstrates some understanding the benefactors have of the institution
because incurables were permanent residents who would live in a state of madness in Bethlem
until death47. Therefore this could suggest sympathy for the plight of the permanently mad and
their families. However Foucault’s argument suggests motivations behind these donations would
not be based on a genuine care for the mad but containment of the ‘irrational’48. Certainly an
article in the General Evening Post supports the confinement of “such ungovernable and
mischievous persons”49 in society as “there is no disease…so terrible in Appearances”50.
42 Roy Porter, Mind Forg’d Manacles, (London: Penguin Books, 1990)
43 White, Henry, “Bethlem Hospital”, Whitehall Evening Post, October 16th, 1784
44 ibid
45 ibid
46 “News”, London Evening Post, June 30, 1760
47 Jonathon Andrews et al, The History of Bethlem, (London: Routledge, 2013 )
48 Michel Foucault, Madness and Civilisation, Trans Richard Howard. (London: Routledge, 2001)
49 Considerations upon the usefulness and necessity of establishing an hospital”,General Evening Post, November
22-24, 1750, Issue 2648
50 ibid

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However this article and a wealth of others in London newspapers discuss in length how the
treatment of the patients, “every Room must have a separate Patient, and Diet”51, should be in
Hospitals and asylums such as Bethlem. Articles on Bedlam use compassionate language to
describe the mad “that Part of the People, whose circumstances in life enable them to be the
Protection and Support of every Work of Benevolence, every Labour of Love”52. Therefore the
media does not portray any evidence to support Foucault’s main point in Madness and
Civilisation. Instead it portrays that Bethlem was viewed as an important institution capable of
alleviating the unfortunate circumstances of the insane although, as formerly mentioned, it did
not have the facilities to “receive”53 enough people for demand.
Therefore in the mainstream media the image of Bethlem remained that it was inefficient
although support for the institution was evident in in the tone of articles that criticized the
institution from a balanced viewpoint. It was also evident through the biased reporting of the
London Evening Post and in Bethlem’s donations. The newspapers highlight Bethlem’s public
image as a necessitous institution for London and the mad.
Aside from the media there was discourse and gossip across classes that sought to expose the
disturbing truths of Bethlem. In London, Bethlems’ resilience as the only symbol of madness for
centuries bred a familiarity with the English population, to the point the public created the
colloquialism “Bedlam” for the hospital in its earlier years54. So prevalent became Bedlams’
stereotypical image of chaos and uproar that it came into being as a noun to describe an
51 ibid
52 J.T, “To the printer of the London Daily Advertiser”, London Daily Advertiser, April 6, 1751
53 White, Henry, “Bethlem Hospital”, Whitehall Evening Post, October 16th, 1784
54 Simon Cross, “Bedlam in Mind”, European Journal of Cultural Studies 15, (2012): 19-34

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uncontrollable situation or noise55. Therefore this nickname, so integrated in discourse, imposed
a negative connotation of Bethlem within gossip before their audience could decide upon its
opinion for themselves.
Certainly much gossip arose from the visits to ‘Bedlam’, prevalent until they were greatly
restricted in 177056. This is because it was a “tourist attraction alongside the lions in the Tower
and the attractions of Bartholomew’s fair”57. Visitors no doubt passed on their observations in
gossip58 considering Bethlem’s popularity and gossip, as a form of entertainment, favoured the
horror stories of Bedlam rather than its positive public image. In 1753 an anonymous
correspondence to The World newspaper suggested, as Foucault did, that insanity had become a
public spectacle at Bethlem “for general delight”59. Visitors were described as “a holiday mob”60
of “savage Indians…who suffered unattended to run rioting up and down the wards making sport
and diversion of the inhabitants”61 before laughing in “triumph”62 at the “ravings they had
occasioned”63 in the ‘lunatics’. Such accounts to Bethlem were often embellished and though this
was a reader’s letter, the editor of this short-lived newspaper stated that “My design in this paper
is to ridicule, with novelty and good-humour, the fashions…and absurdities, of …the human
55 ibid
56 Roy Porter, Mind Forg’d Manacles, London: Penguin Books, 1990
57 ibid
58 ibid
59
Michel Foucault, Madness and Civilisation,
60 The World, June 7, 1753; Issue XXIII.
61 Ibid
62 ibid
63 ibid

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species…"The World"64 . Therefore he no doubt chose to print it in amusement to its
resemblance of a fictitious over exaggerated account. In their bias and hindsight, those that did
recount their visit to Bethlem created a division between themselves, as humanitarians
disheartened by the sight of madmen, and those around them who indulged in it65. This suggests
there was, amongst some of the public, those who felt that Bethlem’s public image was of a form
of entertainment. But on the other hand, the writer of the newspaper article projects that one
should be ashamed of such a perception. Poet William Cowper channels the paradox in his
account to Bethlem how “the Madness of some of them [the patients] had such a humourous air
and displayed itself in so many whimsical freaks, that it was impossible not to be entertained…
but I was angry…I was entertained” 66.
As for the mad themselves, science had contributed to eighteenth century discourse, by teaching
that spoken words emanating from ‘lunaticks’ were merely ‘rantings’ and ‘ravings’ and nothing
more67. As the term suggests it was believed madmen and women offered no authentic
information to their condition or truths of sufferings68. In fact, accounts of visitors to Bethlem
demonstrate the speech of the mad was a source of comedy for some. Joseph Addison, an
64 Edward Moore, “Classified Ads”, The World, January 4, 1753; Issue I.
65Colin Gale, “The Lost Hospitals of London: Bethlem Hospital - Worth a Visit?”, Gresham College,Accessed
December 14, 2013, http://www.gresham.ac.uk/lectures-and-events/the-lost-hospitals-of-london-bethlem-hospital-
worth-a-visit
66 William Cowper, The Life and Works of William Cowper, (London: Saunders and Otley, 1835), Letter to Rev
John Newton dated 19 July 1784, vol ii pg 289
67 Roy Porter, Disease, Medicine and Society in England 1550-1860, (Cambridge: Cambridge University Press,
1995)
68 ibid

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essayist recalled his visit to Bethlem in which a woman commented “ I was highly entertained: I
met with some very amusing subjects: and I heard a great many excellent stories”69. Similar
exclamations are made in fictional accounts to Bethlem such as in Henry Mackenzie’s novel The
Man of Feeling70, discussed in Chapter Two, popularizing the view that the mad of Bethlem
could not be trusted to speak the truth.
Therefore discourse indoctrinated eighteenth century society into associating chaos with
Bethlem’s public image in relation to its visitors and patients, which were incapable of
reasonable conduct and coherent speech, respectively. Gossip popularized a negative public
image of Bethlem that has been maintained to the present day.
The Impact of Art
From the Augustan age “sights and shows in London were promoted”71 and “had grown large
enough to support a wider range of permanent places of recreation than previous centuries had
known.”72 Coincidentally art imprinted ideas of madness onto the middle and upper classes and
misled the public into the artistic and imaginative depictions of Bedlam and madmen that are not
rooted in factual evidence73. The nature of art is to excite emotions, unsurprisingly then, there is
little art that depicts Bethlem as a humanitarian charity with a level of high organisation. Instead
there is an abundance of portrayals exposing the terrifying patients, in a state of chaos and
unsanitary conditions. There are limitations to what art can reveal of reality as Porter is keen to
69 Joseph Addison, Interesting Anecdotes,Memoirs, Allegories, Essays and Poetical Fragments. London: Printed
for T.N Longman, 1796, 3 vols, vol ii, pp83-96
70 Henry Mackenzie, The Man of Feeling.1771.(Oxford: Oxford World Classics, 2001)
71 Pat Roger, Literature and Popularculture eighteenth century England,(London: Harvester Press, 1985)
72 ibid
73 Roy Porter, Mind Forg’d Manacles, (London: Penguin Books, 1990)

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conclude art reflects only art74. However where art is not factual is expresses an opinion, a biased
point of view but one nonetheless, and this is the concerning principle behind uncovering the
public opinion of Bethlem.
Originally published in 1735, Scene in a Madhouse, the final plate in William Hogarth’s the
Rake’s Progress series, in 1763 is “Retouch’d by the Author.”75The etching depicts Bethlem as a
dark place, the only light emanating from a small barred window. It is a chaotic scene with a dog,
madmen, visiting ladies and a mad-doctor. Tom Rakewell the main character is chained by the
ankles and, in his vulnerable state, is naked and hairless “symbolic of his state of mind”76. The
varying body language of each madman, one playing with string, another calculating longtitude,
Rakewell in distress on the floor, adds to the general confusion and commotion in the Hospital.
There is nothing to suggest Bethlem is a place of healing but gives Bethlem a frightening public
image to its audiences of a place without freedom, physically or mentally. In the eighteenth
century Hogarth became famous for his engravings77, such as Scene In a Madhouse and his
appeal was not only to the rich but engravings “were sold in large numbers to people who would
not have been able to previously afford art.”78 His art also influenced Europe and the pre-
74 ibid
75 William Hogarth, “Scene in a Madhouse”,1763 etching, 35.5x40.7cm, in British Museum Collections Online,
Accessed January 3, 2014,
http://www.britishmuseum.org/research/collection_online/collection_object_details.aspx?objectId=1421864&partId
=1&searchText=A+Rake%27s+Progress&page=1
76 Fiona Haslam, Medicine in Art in Eighteenth Century Britain, (Liverpool: Liverpool University Press,1996)
77 Larry Shiner ,The Invention of Art: A Cultural History.(Chicago: Chicago University Press, 2003)
78 “William Hogarth”, Artble, Accessed January 6, 2014. http://www.artble.com/artists/william_hogarth

19
Raphaelite brotherhood artists of the nineteenth century.79 It is safe to assume that this negative
public image of Bethlem influenced a wide audience across decades including 1750-1800.
The etching also introduces the well-known cliché’s in categories of madmen to be found in
Bedlam also prevalent in Richard Newton and Thomas Rowlandson’s art. Most immediately
there is the melancholy figure of Tom Rakewell with “a patch below his right breast”80
signifying an act of self-harm he has tried to commit and in the room behind is a religious fanatic
with a menacing face, a wooden cross and his hands interlinked, suggesting he is perhaps
praying or talking to God. These two characters are a testimony to the architecture of Bethlem
itself, the most immediate form of art to the general public. The sculptures of Melancholy and
Mania were created by Caius Gabriel Cibber for the gates of Bethlem81 and reinforced the
commonplace definition of madness the introverted, worried, self-doubting pessimist82 that
possibly considered suicide and the wild, loud, raging lunatic, whose anger and confusion is
exhibited through sudden actions83. This statue of madness was “both a familiar landmark to
citizens and a grim foretaste of the sight of afflicted inmates.”84
79
Frederick Antal, Hogarth and His Place in European Art. (London ,1962)
80 Fiona Haslam, Medicine in Art in Eighteenth Century Britain, Liverpool: Liverpool University Press,1996
81Bynum. W.F, Roy Porter and Michael Shepherd (eds) The Anatomy of Madness, Vol 1 People and ideas
(London:Tavistock, 1985)
82 ibid
83 ibid
84 Fiona Haslam, Medicine in Art in Eighteenth Century Britain, Liverpool: Liverpool University Press,1996

20
In Richard Newton’s etching “A Visit to Bedlam” there is also a man who suffers from
believing he is a king85, similarly in The Rake’s Progress this is stylized by a crown placed upon
their head and in Hogarth’s work also a mirror, displaying narcissism 86. John Haslam, the
Bethlem apothecary in his Observations of Madness, writes of a patient in Bethlem who
“sometimes he conceived himself the King of Denmark, at other times the King of France.” 87 He
also recalls patients suffering from “religious terror”88. Therefore art here reflects the existence
of these real characters which are a part of Bethlem’s public image and no doubt would have
been visited by the general public before 1770.
However for Hogarth and others, images of Bethlem were often politically or socially motivated.
Fiona Haslam concludes “A Rake’s Progress” was celebrated in its promotion of a moral code in
ways of living89 rather than its denunciations of Bethlem. However this effect is only gained by
the audience perceiving a similarity between themselves and Thomas Rakewell, he is a portrayal
of how easily humans can fall into immorality which leads to misery.
85 Richard Newton, “A Visit to Bedlam”, 1794 hand-coloured etching, 34.5cm x 24.7cm in n British Museum
CollectionsOnline, Accessed January 3, 2014,
http://www.britishmuseum.org/research/collection_online/collection_object_details.aspx?objectId=753993&partId=
1&searchText=a+visit+to+bedlam&page=1
86 William Hogarth, “Scene in a Madhouse”,
87 John Haslam, Observations on Insanity. (London: printed for F and C. Rivington, 1792)
88 ibid
89 Fiona Haslam, Medicine in Art in Eighteenth Century Britain,

21
In stark contrast to the negative depictions of Bethlem, there is a print made for a book on the
history of London in 175890 that presents the asylum as a picture of reason and organization.
The building is drawn in symmetry, except for the figures (potentially patients) which roam the
open passage to the entrance, whom, presumably the audience is to perceive, will be discharged
in a state of mind as balanced as the building itself.
Fig 1: Anonymous, “BethlehemHospital”, 1750
Source: William Maitland, 20.6cmx 30.1cm, in HenryMaitland“The History andSurvey of Londonfrom its Foundation to thePresent Time”
(London: T. OsborneandJ. Shipton, 1756)
However this picture does not capture the riot’s during the holiday visiting and nor does it show
how decrepit the building became as it began to fall apart during the last decade of the eighteenth
century91. Coincidentally and consequentially this is when public opinion of Bethlem began to
waver and there was an increase in competition for Bethlem, as more private and public
90
Anonymous, “Bethlehem Hospital”, 1750 print, in William Maitland, 20.6cm x 30.1cm, in Henry Maitland “TheHistory and
Survey of London from its Foundation to the Present Time” (London: T. Osborne and J. Shipton, 1756)
91 Jonathon Andrews et al, The History of Bethlem, London: Routledge, 2013

22
madhouses were opened claiming to be better, such as the York Retreat in 179292. The picture
promotes Bethlem, in its bias, promoting London, as is the books purpose.
But from 1750 to 1790 indeed the building was impressive, as satirized in Ned Ward’s London
Spy “ I conceiv’d it to be my Lord Mayor’s Palace, for I could not image so stately a structure
could be design’d for any Quality inferior”93. It was featured in guidebooks due to its “grandeur94”
and “curiosity of use.95” Its appearance was in some part due to its need to attract donations from
rich men but also the grand architectural structure of the building suggested to the public it
would have a greater standard of mad-doctoring than other charities.
The upper classes were also influenced by the theatre and madness was intriguing to depict on
stage96 and as the general audience were not engaged in the most recent of scientific knowledge
regarding madness, what mattered was its face, how madness appeared on the surface97. David
Garrick the owner of the Drury Lane theatre “signally advanced the popularity of Shakespeare
plays”98 in the mid eighteenth century which comprised of King Lear, Macbeth and Hamlet that
offered depictions of madness within their scripts.
92 ibid
93 Ned Ward, “A Visit to Bedlam, in The London Spy, London, 1703
94 “London and its Environs”, London Evening Post, October 11-14 1760, Issue 5140
95
ibid
96 Roy Porter, Mind Forg’d Manacles
97 ibid
98Robert Caruthers and Adolphus William Ward. Encyclopedia Britannica Eleventh Edition ,(Cambridge:
Cambridge University Press, 1910). P 475-77

23
Garrick often omitted and altered scenes from Shakespeare and his portrayal of Hamlet was
edited so that the gravedigger scene in Act 5 was cut99, a scene that offers its audience an
abundance of comedy. This scene is usually sandwiched in between Ophelia’s death and
Hamlet’s realisation that the woman he loved has died. Garrick avoids this delay in tragedy
which William Richardson, a critic in 1774, classified as a “delay [which] cools our impatience;
it diminishes our solicitude for Hamlet, and almost lessens him in our esteem”100. Instead more
sympathy is created from the audience towards a tragic man of consequence101 whose feigning of
madness has resulted in the loss of his love:
forty thousand brothers
Could not with all their quantity of love
Make up my sum.102
In Hamlet on the Couch Bynum suggests the seventeenth century would not have portrayed
Hamlet in this way 103but perhaps as genuinely mad and uncontrollable as in seventeenth century
society madness often coincided with ideas of witchcraft and was thought of as an affliction that
could not be redeemed104. But in the eighteenth century popularizing Garrick’s version of the
99 William Richardson, Essays in Shakespeare’s dramatic characters, (London: printed for S. Bagster, 1774)
100 ibid
101
W.F Bynum and Neve, Michael. “Hamlet on the couch”. In The Anatomy of Madness Volume 1. ( London:
Tavistock Publications Ltd, 1985)
102
William Shakespeare. Hamlet.1603.Ann Thompson and Neil Taylor ed. (London: The Arden Shakespeare, 2006)
103 W.F Bynum and Neve, Michael. “Hamlet on the couch”.
104 Michael Macdonald, Mystical Bedlam, (Cambridge: Cambridge University Press,1983)

24
play in which Hamlet is a victim of madness (he must pretend to be mad to seek revenge and he
loves mad Ophelia who kills herself) encouraged audiences to question how far madness
removes one from normal society or whether like Hamlet and his melancholy character, lunacy is
fleeting or can be cured. The moneyed Londoner’s who saw this play were possibly influenced to
contribute to the charity of Bethlem to save other Ophelia-like women or simply began to
perceive the human behind the lunatic, in the words of Polonius:
Though this be madness, yet there is method in’t105
This type of art contributed to the change in attitudes in the mid eighteenth century in relation to
lunatics. A different sentiment steadily built up to the nineteenth century of sympathies for the
insane and new understandings of what was humane in relation to treatments. This would
eventually lead to the investigations into poor patient treatment in Bethlem Hospital in 1815 and
other asylums106.
The growing sentiment for lunatics in Bethlem is further explored in Henry Mackenzie’s novel
The Man of Feeling published in 1771107. The reader is presented with a character who is
reluctant to visit Bethlem , “[one of] those things called Sights”108. Although the main character
Harley is not radical enough to suggest visits are detrimental to the patients only the tourists
themselves “I think it an inhuman practice to expose the greatest misery with which our nature is
afflicted… especially as it is a distress which the humane must see, with the painful reflection,
105
W.F Bynum and Neve, Michael. “Hamlet on the couch”.
106
Porter, Roy. The Faber Book of Madness. London: Faber and Faber, 1991.
107 Henry Mackenzie, The Man of Feeling.1771.(Oxford: Oxford World Classics, 2001)
108 ibid

25
that it is not in their power to alleviate it.”109 Although it does offer a critique on part of the guide
routinized in entertaining guests, who is “surprised at their uneasiness”110 and compared to those
“who keep wild beasts for show”111. This exhibits the drift from seventeenth century fascination
with inhumane crazed beings112, which the guide symbolizes, to a sympathetic age where Harley
and his friends perceive a basic human similarity to the patients113.
Overall the architecture of Bethlem lent itself to a positive public image despite the horrors
depicted in literature and images. As the mid-eighteenth century continued however art began to
impact on society by suggesting the mad and the sane were not so far removed from one another.
Amongst this time period the stereotypes of different categories of madness were further
imprinted in art which reflected current scientific understanding of mental illness.
Political Influences
As caricatures became more political they too depicted Bethlem in a negative yet comical light
by which to discredit politicians such as Charles James Fox. He was an especial target for etchers,
such as Isaac Cruikshank, James Gillray and Thomas Rowlandson,114to depict in Bedlam as a
madman due to his public image as a Whig Statesman whose ambitious bills and French
109 ibid
110 ibid
111 ibid
112 Michael Macdonald, Mystical Bedlam, (Cambridge: Cambridge University Press,1983)
113 Jonathon Andrews et al, The History of Bethlem, - BETTER FROM A CRITIC OF THE BOOK
114 Tamara Hunt. Defining John Bull: Political Caricature and National Identity in Late Georgian England ,(
Hampshire: Ashgate,2003)

26
sympathies did not lend itself to their political views115. More seriously, during King George
III’s reign Margaret Nicholson’s failed regicide also generated much intrigue into madness.
Nicholson became a prominent and positive public figure which reflected well upon the
institution where she was confined, Bethlem Hospital.
Rowlandson creates an image of Charles James Fox with the Bethlem Physician Dr John
Monro ,116 “in which Fox’s supposed lunacy is attributed to the disappointment of excessive
ambition.”117 This ambition is also satirized by Isaak Cruikshank’s etching “Fox in Bedlam”
118which depicts him on a bed of straw suffering from delusions he is a king because he is certain
of the success of his India Bill of 1783119. The Bethlem scene creates the comedy in the image
115 Amelia Faye Rause, Caricature Unmasked: Irony, Authenticity,and Individualism in Eighteenth- century English
Prints, (New Jersey: Associated University Presse,2008)
116 Thomas Rowlandson, “The Incurable”, 1784 Print, 24.6cm x 30.3cm, in British Museum Collections Online,
http://www.britishmuseum.org/research/collection_online/collection_object_details/collection_image_gallery.aspx?
assetId=156295&objectId=1645252&partId=1
117 Schupbach, W. "Illustrations from the Wellcome Institute Library. John Monro MD and Charles James Fox:
etching by Thomas Rowlandson." Medical history 27, no. 1 (1983): 80.
118 Isaac Cruikshank, “Fox in Bedlam”, 1784 etchings,17.8 cm x 25cm, in British Museum Collections Online,
119
ibid

27
because it is outside of society therefore stripping Fox of the authority he has in reality, as a
politician.
Fig 2: Thomas Rowlandson, “The Incurable”, 1784
Source: British Museum Collections Online
Fox, typically for his caricature, is pictured as a very plump man in “The Incurable” which
highlights a tendency for excess. His hair, entangled and unruly and the strait jacket depict his
obvious distress; he is the epitome of unreason. This portrayal of Fox allows Rowlandson to cast
Dr Monro as the mirror image of the politican, equally both are mad. For example there is a stark
comparison between the size of the politician and the small magnifying glass Monro uses to
examine him. This is wholly unnecessary considering Charles Fox’s madness is so visually
depicted and orally through his song
“My Lodging is on the Cold ground and very hard is my Case

28
But that which grieves me most if the Loosing of my Place”.120
Therefore it portrays a public image of Dr Monro as a quack doctor of superfluous methods and
his efficacy is further questionable in respects to his age, accentuated by the lines and shadowing
on his face. As the physician of Bethlem, Monro was symbolic of the institution, and therefore
this image reflects badly on Bethlem Hospital for the same suggestions, that it was an aging
Hospital losing its credibility. Using Bethlem in political caricatures gave its negative image
further exposure to a part of the public who were not reached by serious art such as literature or
could not afford it.
What is proved here is the cultural normality to satirise madness although this had decreased
since the Augustan age121; Bethlem was not a taboo issue amongst the political sphere. Political
art gave Bethlem’s public image some comedy, intrigue and horror but fell short of seriously
critiquing any of its practices.
Steve Poole provides evidence in “The politics of regicide in England” that people considered
“dangerous” to the King were confined in Bethlem122. He notes the case of Thomas Stone, who
“in 1787 begged the Queen to let him marry the Princess Augusta Matilda” 123 and was
subsequently sent to Bridewell then Bethlem. This follows Foucault’s argument that the
government sought to rid society of those ranging from “petty annoyance to [disperser’s] of
seditious literature [to] passers-by offering themselves in marriage”124 with “dubious”125 legality
120 ibid
121 Jonathon Andrews et al, The History of Bethlem
122 Steve Poole, The Politicsof Regicide 1760-1850,( Manchester:ManchesterUniversity Press, 2000)
123 ibid
124 Patricia Allderidge, “Criminal Insanity: Bethlem to Broadmoor”, History of Medicine 67, no.1 (1974)

29
because it suited them to do so. This was often carried out by the Board of the Green Cloth,
suggesting they saw Bethlem’s image as a dumping ground for unwanted “people who hung
about royal palaces or royal persons.126” These people were not few or rare in numbers, partly
due to the fact King George was a contractual king, expected not just to accept the petitions of
their subjects but to respond to them.”127 Many petitions were ignored, often the ludicrous ones
which asked for the King’s hand in marriage and to have his children, as was the content of
Margaret Nicholson’s letters to the King128, his future assassin. However this forced confinement
was more prevalent in the late eighteenth century after the French Revolution when “there was
concern amongst minsters about the ideological threat posed to the King by emissaries of the
French Revolution, especially after the outbreak of war in 1793.”129
Margaret Nicholson, a woman driven mad apparently by her loss of a lover had become on
obsessive admirer King George III, resulting in her attempt to stab him outside St James
Palace130. It was a reminder to the public of one of the categories of madness that could ensure
persons find themselves, as Nicholson did, inside Bethlem. The stereotype of the love-sick lonely
woman often a feature of songs and poems:
I heard a maid in Bedlam who mournfully did sing
Her chains she rattled with her hands, while
125 ibid
126 ibid
127 Steve Poole, The Politicsof Regicide 1760-1850,
128 ibid
129 ibid
130 Catherine Arnold, Bethlem and its Mad, (London: Simon and Schuster, 2008)

30
Sweetly thus sung she
I love my love…
Was the ship that took my love from me.131
The publicity for the King in the aftermath of his attempted stabbing was positive and the fact
that Nicholson wasn’t castigated meant that George’s mercy boosted his endearing image132.
Nicholson’s image was favourable also and she was treated well by “Mr Coates, the King’s
messenger”133, whom it was reported played whist with Nicholson whilst she was under his
custody134. Another book recounting the attack presents her as a polite woman but of unsound
mind who entered Bedlam calmly135. Engravings were being sold of Nicholson’s attempt on the
King, as was a publication “Authentic memoirs of Margaret Nicholson” in The Morning Post
and Daily Advertiser136. In a paper in 1799 she is still referred to as “the famous Margaret
Nicholson”137 a year earlier there are updates on her health in Bell’s Weekly Messenger138. Only
the Morning Post and Fashionable World opts not to sympathise with “the lunatic conduct of
131 Anonymous,“Maid of Bedlam” , A collection of new songs, Worcester,1765 in Eighteenth Century Collections
Online, Accessed January 6, 2014
132 Steve Poole, The Politicsof Regicide 1760-1850,
133
Morning Post and Daily Advertiser, August 5th 1786, Issue 4202
134 ibid
135 Anonymous,The plot investigated;or,a circumstantial account of the late horrid attempt of
Margaret Nicholson to assassinate the King. (London: printed for the authorand sold by Mr. Macklew, 1786)
136 The Morning Post and Daily Advertiser, August 8th 1786, Issue 4202
137 Sun, April 4th 1799, Issue 2038
138 Bell’s Weekly Messenger, February 9th, 1799, Issue 2119

31
Margaret Nicholson”139 in 1794 contrasting with the Daily Gazette which empathetically
describes her as an “unfortunate woman, of whose derangement of intellect the public has heard
so much”140. The fact that Nicholson was a source of intrigue for audiences, lent itself to
Bethlem’s public image, for the general public did not understand Nicholson’s motives and
public persona but they clearly wanted to. Therefore Dr Monro became a man who held the
secrets behind such a mad illness, a positive reflection on his expertise. As mentioned in Chapter
four the mad-doctor was increasingly trying to demonstrate his necessity and seniority through
professing to have greater knowledge of madness than the general public could ever acquire141.
Ironically a few years after the Margaret Nicholson affair King George III suffered from his own
plight of madness142. King George’s illness was a factor that popularized “the English
malady”143 which was a “hypochondriac melancholy”144 granted as fashion amongst the upper
classes. This differentiated the melancholic hypochondriacs often poor, confined to Bethlem
from the rich who remained in society such as politician, William Pitt the elder. George Cheyne
in “The English Malady” saw such an illness as a mark of “cultural superiority- wealth and
intelligence – which he also claims for the British”145. Except, of course, when such an illness
139 Morning Post and Fashionable World, November 16, 1974, Issue 1794
140 Daily Gazette
141 Andrew Scull, Charlotte Mackenzie and Nicholas Hervey, Masters of Bedlam,(Princeton University Press, 1996)
142 Catherine Arnold, Bethlem and its Mad,
143 Thomas Szasz, The medicalization of everyday life,(New York: Syracuse University Press, 2007)
144 ibid
145 Dana Kopans, The English Malady:Engendering Insanity in the Eighteenth Century.(PHD thesis,Carnegie
Mellon, 2006)

32
led to “self-murder”146 or suicide and it frequently did. Therefore the English Malady created a
class divide between the melancholy hypochondriacs of Bethlem and the rich sufferers of “The
English Malady.”
To the outside world, it was seen as a “disease of civilization”147 that did not affect other
societies outside of England148. The high rate of suicides was something the French had made
jokes about over centuries149 but at the same time had attracted them to England in curiosity150.
With many melancholic and nervous sufferers confined in Bethlem, its one factor to
understanding its draw for foreign visitors.
Politics therefore had a varying impact on Bethlem’s public image. Amongst the opposition of
the Foxite’s it was a political tool which consequently gave Bedlam an atrocious image. But the
limitation of these critiques is that they were probably not taken very seriously. Though there
were few laws “for the provisions of lunaticks”151, the government still found a means to
imprison certain persons in Bethlem, displaying their disregard for it as an asylum to cure the
mad and their image of Bethlem as a place of confinement. Through Margaret Nicholson’s
attempted regicide sympathizing with the mad became ever more popular as did the public image
of King George III. It created positive intrigue into Nicholson and therefore the institution that
146 George Cheyne, The English Malady, ( London: printed for G. Strahan, 1733)
147 ibid
148 Roy Porter, Mind Forg’d Manacles,
150 ibid
151 Considerations upon the usefulness and necessity of establishing an hospital”, General Evening Post, November
22-24, 1750, Issue 2648

33
held the secret to her treatment. She was also a walking stereotype of the love- torn madwoman
which was classed as a condition in Bethlem Hospital152.
Science and Mad-Doctoring
The second half of the eighteenth century relied on the concepts of two main categories of
madness, mania and melancholy, 153 with various sub-categories, of which some have been
previously described; the love-sick, the hypochondriac and the religious fantasist. There were
growing debates and competition among mad-doctors over who had the most effective diagnoses
and treatments for the “insane”154. Fox example, John Haslam, the apothecary to Bethlem from
1782, did not agree with his superior Dr John Monro. Haslam believed madness was a unitary
disease of the body whilst Monro believed only the mind was damaged 155. The expanding
demand for medical services alongside the growing economy made entrepreneurs out of men
who wanted a medical career156, which led to growing interest in madness. The growing interest
in madness caused a mass of literature written by mad-doctors as well as ex- patients and
campaigners for asylum reform of which Bethlem was often discussed.
It was well known that “the post of physician to Bethlem was occupied by a veritable dynasty of
Monro’s” 157 which had been the case for a century. This reflected positively on the institution as
152 William Black, An arithmetical and medical analysis of the diseases and mortality of the human
species,(London: printed for the author by John Crowder,1789)
153 Edwin.R.Wallace IV and John Gach, History of Psychiatry and Medical Psychology.(New York: Springer, 2010)
154 Andrew Scull, Masters of Bedlam
155 ibid
156 ibid

34
many newspaper obituaries report deaths at the hands of “a quack [doctor], who ignorantly bled
the unhappy Lady in a Milk Fever.158” Or as the True Briton159 found it essential to note on the
death of Dr Hugh Hodge “a physician of the city” he was “neither Fop, Pedant,Quack, Lunatick
or Sycophant”.160 These newspapers show the uncertainty of the middle classes as to the quality
of men in the doctoring trade as “The physician often had no practical training and his education
was mainly academic and classical… but some of these… degrees and licenses from
universities…were bogus and some practitioners had failed to complete their courses.”161 A
criticism Bethlem from the public, was without.
Haslam at many points in “Observations of Insanity” stresses the differences between what the
general public, “unaccustomed to insane people”162 perceive in the mentally ill, in comparison to
himself as a medical professional. He notes how on meeting ‘lunatics’ “people are frequently led
to conclude, that, if during a conversation of a few minutes, a person under confinement shall
betray nothing absurd or incorrect, he is well”163. Scull reminds us that this persuasive technique
was a motive of Haslam’s and other doctors, such as William Pargeter of St Bartholomew’s
Hospital164, to make it appear necessary to those unfortunate families to send an “insane” relative
to Bethlem under an experienced eye. Therefore there was a widening gap being created between
158 London Intelligencer,January 9 1750, Issue 611
159 True Briton , October 20, 1798, Issue 1818
160 ibid
162 John Haslam, Observations on Insanity. London: printed for F and C. Rivington, 1792.
163 John Haslam, Observations on Insanity

35
the general population’s understanding of mental illness and mad-doctors attempting to persuade
them of this disparity.
Nevertheless it is more than likely during visitation of the asylum there were many “maniacs” on
show who were experiencing these “lucid intervals” 165 , Haslam describes. And in their
experience of such a patient saw “the injustice of secluding him from the world”166.
Haslam ends each patient case with how they died and an autopsy of their brain, the lack of
explanation for their deaths demonstrates the gap in medical knowledge in the eighteenth
century.167 The lack of post mortem procedure, which takes place varying from two hours after
death to two days168, showcases the individualism and experimentation in the methodology of the
career. John Gozna, the previous apothecary to Bethlem had different procedures. Therefore the
variety of mad-doctoring in the eighteenth century meant there was a lack of collective scientific
knowledge available to the public on madness in Bethlem and other asylums.
Therefore when the public image of Bethlem held in the balance, due to the debate waged
between William Battie and John Monro, it depended more on the social dynamics of London
itself to decide who was correct in how to treat “lunatics”. William Battie, physician and founder
of St Luke’s Hospital,169 wrote his Treatise on Madness in 1758 and Monro responded just
months later with Remarks on Dr Battie’s Treatise. Two of Battie’s statements that Monro
perceived as attacks on Bethlem, were the morality of its physicians and the labeling of madness
166 ibid
169 Leonard Smith, Lunatic Hospitalsin Georgian England 1750-1830.(London:Routledge, 2013)

36
as “original”170 and therefore incurable. This threatened Bethlem’s public image of hope that
Londons’ madmen could be cured. Battie also explains “The parent of medical science, has
profited little” 171 due to physicians maintaining their own knowledge of patients and not
subjecting it to “proper communication”172 amongst the public. This suggests that Bethlem is
ran by doctors and governors who use… mean arts either to procure patients or to keep them”,173
which Monro vehemently denies. Battie also accuses certain physicians of using “ traditional
knowledge… indiscriminately reduced to practice, a little experience will soon make him wish
he had been an entire stranger to.”174 In this sense he refers to physic, Hellebore, Antimonial
vomiting and strong purges175 which Monro also denies use of “as specifically anti-maniacal”176.
Battie demonstrates some of the arguments which other medical men agreed with such as those
who sought to “morally manage”177 the insane rather than through medicines and physic178,
notably William Tuke at the York Retreat179. William Pargeter in his “Observations on Maniacal
Disorders” also criticizes Bethlem indirectly through his statement “that in the course of almost
170 John Monro, “Remarks on Dr Battie’s Treatise on Madness”,(London : Printed for John Clarke,1758), Bristol
University Medical Library
171 William Battie, A Treatise on Madness. (London: printed for J. Whitson and B.White,1758)
172 ibid
173 John Monro, Remarks on Dr Battie’s Treatise on Madness
174 William Battie, A Treatise on Madness.
175 ibid
176 John Monro, Remarks on Dr Battie’s Treatise on Madness
177 W.F.Buynum and Roy Porter, Companion Encyclopaedia of the History of Medicine.(London: Routledge, 2013)
178 ibid
179 ibid

37
three thousand years no medicines have been discovered upon which any reliance can be
placed”180. William Battie’s was the first significant critique of Bethlem with any sizeable
audience, written by a respectable man of medical profession181and it began to turn the medical
community against Bethlem. Certainly the debate between moral management and medicine
raged in the last decade of the eighteenth century seeking to discredit the public image of
Bethlem as an asylum of superfluous treatments.
Other Londoner’s sought to reform Bethlem and its treatment of patients but serious critiques of
the confinement system for the mad however were not pervasive until the nineteenth century182.
Therefore Bethlem 1750-1800 was still one of many asylums throughout the country of which
popular public opinion was satisfied with.
Many people suffering from mental illness did write and express their first hand experiences in
asylums, such as William Belcher. It would be foolish to digress into how his obvious distress, at
the hand of mad-doctors, had any significant impact on the asylum’s public image until the
nineteenth century when scientific ideas considering the value of their patients discourse
developed183. Yet this theses and others written by ex-inhabitants of madhouses, are integral to
demonstrating how the views on Bethlem and private institutions were beginning to cause
undercurrents of protest in the late eighteenth century. Belcher’s pamphlet includes a letter
180 William Pargeter, Observations on Maniacal Disorders. (Reading: printed for the author,1792)
182 Catherine Arnold, Bedlam and its Mad
183 Roy Porter, Voices of Madness. (Gloucestershire: Sutton Publishing, 1997)

38
addressed to the principal physician at Bethlem from 1792 Dr Thomas Monro184, who he owed in
part to his release from a private asylum in Hackney185 where he appears to have been wrongly
confined. Despite his gratitude for Monro he condemns the ‘”trade in lunacy”186 and presents his
fear that “no man is safe from living and dying in a strait waistcoat, in which I have lain all
winter nights abound.”187 Indeed he goes on to describe his unfortunate circumstances of being
“cold from want of bed-clothes, a sufficiency not being allowed me, whilst in perfectly in my
senses as I am now”188, ironically the very man he was thanking in this fictional letter was
performing similar treatments at Bethlem.
Lastly, many patients and families may have viewed Bethlem as simply a place to die. From the
cases Haslam describes many patients chose to do so through the rejection of “all food and
medicines”189. Those who did choose to starve themselves often suffered from feelings of guilt
due to the grief of a loved one such as C.H, who after the death of his son, dreamt of his
drowning every morning “he would fancy that he son was drowning, that he had twice sunk: he
was prepared to plunge into the river to save him, as he floated for the last time:” 190
To conclude, science was still far from illuminating cures for the insane therefore the dynasty of
the Monro’s was a more confident testimony to Bethlem’s expertise on madness than any
184 William Belcher, Peace and Reconciliation;To which is added a letter to Mr Fox, in Roy Porter, Voices of
Madness. (Gloucestershire: Sutton Publishing, 1997)
185 ibid
186 ibid
187 ibid
188 ibid
190 ibid

39
particular theses published by mad-doctors. It seems as the eighteenth century continued more
medical professionals disagreed with the theories and practices occurring in Bethlem and in
entering the nineteenth century, Bethlem would indeed be chastised for them. Ex- asylum
patients also contested the “trade in lunacy” adding to the disgust of patient treatment, tarnishing
the public image of madhouses, when, of course, an audience took any notice. And finally it is
not farfetched to presume many patients saw Bethlem as a place to punish themselves and
eventually die from their madness through a choice to starve.
Religion and Madness
During the eighteenth century the one influence that offered an opinion on madness across all
classes was the Bible. Christian theology had long been associated with madness191 but before
the eighteenth century the religious mad were “reputed to be in touch with divine voices, to
witness visions in dreams, [and] utter prophetic truths”192. The Age of Reason which taught
society to rationalise all previous preconceptions, lost tolerance for the town madman who used
to roam the streets in plain view. So too did society value the rational above faith for the first
time contesting the idea of “good” religious madness for a malady or disease193. This was
especially prevalent with the increasingly popularity of Methodism which was bound closely
191 Roy Porter, Madness: A brief History. ( Oxford: Oxford University Press, 2002)
192
Roy Porter, Mind Forg’d Manacles,
193
ibid

40
with the public image of Bethlem Methodism was harshly criticized194 and became a legitimate
cause of madness within asylums.
In Bethlem itself, though founded as a religious institution, in the eighteenth century for the
patients at least it was a Godless place. The Quakers and evangelists who came to visit the sick
were stopped by the Anglican Bethlem governors in 1714195. “Traditional Anglicanism stressed
moderation”196 and religion was viewed by the governors as too heavy a subject for such weak
and unstable minds of the patients, who could easily become fanatical197. Despite this, Bethlem
had its fair share of religious fanatics already, it was said that the poet Kit Smart “prayed so
loudly he drive his neighbours to distraction and had to be committed for his own safety”.198
William Black, a physician, created a number of statistical tables based on the apothecary of
Bedlam from 1772 to 1795, John Gozna199. It shows that 166 patients had been confined to
Bedlam suffering from Religion and Methodism200, “the fourth most common cause of insanity,
accounting for over 10 per cent of all cases.”201 Therefore the presence of religious madness was
194 Misty G. Anderson, Imagining Methodismin Eighteenth-Century Britain. (Baltimore:Maryland: John Hopkins
University Press,2012)
195
Jonathon Andrews et al, A History of Bethlem
196
ibid
197
Jonathon Andrews and Andrew Scull, Undertaker of the mind : John Monro and Mad Doctoring in Eighteenth
Century England,
198 Catherine Arnold, Bethlem and its Mad,
199
William Black, An arithmetical and medical analysis of the diseases and mortality of the human
species,(London: printed for the author by John Crowder,1789)
200
ibid
201
Jonathon Andrews et al, A History of Bethlem

41
a prominent part of the public’s image of Bethlem but for the patients inside it was lacking in
religious guidance.
Nominal Anglicanism202 dominated English religion, however with the creation of Methodism
by Bristolian John Wesley203, his followers began to challenge the traditional denominations.
Though there numbers remained few in England in comparison to Anglicans204, Methodism was
an unwelcomed change and resulted in a wealth of literature condemning preachers such as
Wesley and George Whitefield. But the nature of Methodism, as a religious sect that encouraged
self-flagellation “to please a merciful deity!”205, encouraged critiques, serious and satirical, that
is was a form of madness. These views were shared by many physicians; it was regarded as a
fact that Methodism caused madness206. In William Pargeter’s “Observations of Maniacal
Disorders” he wrote of a man “who attached himself to the Methodists; these deluded people
soon reduced him to the unhappy state in which I found him”207 Therefore it was common
knowledge that a large proportion of Methodists would find their way to Bethlem.
202 Clive Field, “Eighteenth-Century Religious Statistics”, British religion In Numbers. Accessed February 5, 2014,
http://www.brin.ac.uk/news/2012/eighteenth-century-religious-statistics/
203
Misty G. Anderson, Imagining Methodismin Eighteenth-Century Britain.
204
Clive Field, “Eighteenth-Century Religious Statistics”,
205
Erasmus Darwin, Zoonamia: or The Laws of Organic Life. 1794. In The Faber Book of Madness. Edited by Roy
Porter (London:Faber and Faber, 1991)
206 ibid
207 William Pargeter, Observations on Maniacal Disorders. Reading: printed for the author, 1792

42
An anonymous print, “Harlequin Methodist”208 from the British Museum, demonstrates how
closely defined Methodism was with Bethlem. It depicts George Whitefield, a Methodist
preacher, performing to a crowd of varying status as a Harlequin. The preacher having assumed
another character suggests the content of his speech is a fictitious and the print satirizes
Whitefield’s tendency for theatrical speeches209. They are located outside the gates of Bethlem
and although the satirical implications of Whitefields madness is obvious, there was a close
“ physical proximity of the Methodist meeting houses in London (in particular the Foundry and
the Tabernacle) to Bethlehem Hospital.” 210; another reason their public image was so closely
bound. Porter states how “the phrase ‘Methodistically mad’211 became something of a
catchphrase amongst those...contemptuous of the canting Wesleys and Whitefields who fanned
such hysteria” which coaxed “ simple serving maids”212 into fits and often suicide.
In spite of Christian denomination, its theology, that one should love and care for those worse off,
encouraged the general population to think on Bethlem graciously. As for lunaticks, they were
208 Anonymous,“Harlequin Methodist”,1763 print, 17.1cm x 24.7cm, in British Museum Collections Online,
209 Misty G. Anderson, Imagining Methodismin Eighteenth-Century Britain.
210 ibid
211 Roy Porter, Flesh in the Age of Reason.(London: Penguin, 2005)
212 Roy Porter, A Social History of Madness.(London: Weidenfeld & Nicolson, 1987)

43
sent to Jesus to be cured213, and as Bethlem was not a mere asylum but an institution to cure the
insane, it was synonymous with these passages in the bible. Often in secondary sources the story
of Nebuchadnezzar is used to demonstrate how madness was a punishment from God214. In this
story he is reduced to a beast215 which was perhaps a factor as to why early psychiatric
understanding was that lunatics were similarly incapable of feeling the cold and were sinful216. In
times before the eighteenth century, Bethlem patients were beaten upon arrival to rid them of
such demonic possession217. Furthermore Christian teachings of charity are based on the bible
which states “we must help the weak”218 and ‘You shall open wide your hand to your brother, to
the needy and to the poor, in your land.219’ Bethlem Hospital therefore was carrying out God’s
work.
Therefore religion reflected positively on Bethlem’s public image except of course for
Methodism. Methodism’s proximity to Bethlem’s public image was an annoyance for the
Anglican governors of Bethlem220 but it benefitted from the acceptance of many Methodists to
213 Matthew 4:24, “Bibles verses about Insanity”, Openbible.info, Accessed March 3 , 2014,
215 ibid
216 Dinesh Bhugra, Psychiatry and Religion:Context,Consensus and Controversies. (London: Routledge , 2013)
217
Catherine Arnold, Bedlam: London and its mad
218 Acts 20:35, “Bible verses about Charity”, Openbible.info, Accessed March 3 , 2014,
http://www.openbible.info/topics/charity
219Deuteronomy 15:7-11 , “Bible verses about Charity”, Openbible.info, Accessed March 3 , 2014,
220
Jonathon Andrews et al, The History of Bethlem

44
the hospital. This was because religious madness was no longer tolerated in society in the mid to
late eighteenth century.221
Conclusion
In conclusion, the public image of Bethlem was far more balanced 1750-1800 than contemporary
opinion of the Hopital suggests. The media was disposed to praise Bethlem reputing it as an
institiution of benevolence even when acknowledging its failures. Furthermore its architecture
gave Bethlem a sense of grandeur recognized in guide books and other publications promoting it
to the general public as an attraction. But after 1770, when visiting became limited Bethlem and
with the onset of French tensions, government officials such as the Board of Green Cloath used
Bethlem as a dumping ground for unwanted citizens. From the perspective of the general public
however, their interest in Bethlem had diminished since 1770 and it peaked again with
assassination attempt of King George by Margaret Nicholson who found herself a positive
symbol of Bedlamite madness. As for the Monro’s themselves as mad-doctors, were perceived to
be expert in understanding and treating diseases of the mind, until the 1790’s brought with it a
barrage of medical men criticizing Bethlem’s methods as too traditional and ineffective. As for
religion, religious madness was a prominent feature of the patients of the Hospital. Most notably
many Methodists were thought to be mad in their following of the practices of the denomination
and were sent to Bethlem. Furthermore the proximity of the meeting rooms to Bethlem ensured
the public image of Bethlem and Methodism were intertwined.

45
Despite its positive publicity, Bethlem also had a public image of being horrifying due to
inhumanity of the visiting that many perceived and its lack of sanitation and care portrayed in
artistic depictions of the Hospital. Political caricatures and other art also kept the stereotype of
many lunatic characters in the public eye such as the deluded man who believes himself to be
king. As the second half of the eighteenth century wore on Bethlem would become increasingly
less popular due to the decaying of the building, the critiques of medical men and undercurrents
of protest from humanitarian campaigners. Attitudes to the mad had grown sympathetic in
comparison to the Augustan age and before. Finally religion encouraged Bethlem as a charity but
the bible often gave contradicting opinions on insanity.
Word Count:11,000
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