The State Madhouse

The archetypal state madhouse can best be described through the history and description of Bethlem madhouse in London. Bethlem is a good basis and comparison point based on its rich historical background and relevance. The reconstruction of Bethlem was finished in 1676, following the Great Fire of London. The new Bethlem significantly outshined the original: “It was a spectacular gesture of reinvention, not only of London but also of madness itself” (Jay 38). The grandeur of the new Bethlem soon faded as it became clear that the building was built on an unreliable foundation. On the inside of the structure, the walls ran with giant cracks that allowed in wind and rain. The contrast of the near perfect outside with the dilapidated inside paralleled Bethlem’s reputation. At its inception, Bethlem was meant to be a safe place for the mentally disabled. However, it slowly devolved into a place rife with abuse and malnourishment (Jay 39).

The inmates were regularly cleaned and shaved, and they were occasionally attended to by a surgeon. However, they were never given therapy for their mental conditions. The surgeons performed procedures, such as bloodletting, purging with emetics (making them throw up using medicine), and cold showers, aimed at balancing the humors of the patients. The primary rationale behind these treatments was to make the patients less violent. The priority of the caretakers was to maintain order within the institution, so more often than not, patients were treated with bloodletting and purging with the intention of making them easier to handle (Jay 52). The treatments essentially evolved into threats as opposed to legitimate attempts at caring for the patients.

The image above, “Gentle Emetic” by James Gillray (Wellcome), portrays a typical treatment for certain mental illnesses during the Romantic period. The patient above is being given an emetic so he will eventually vomit.  The idea behind this was to balance the four humours within the body to soothe the patient’s symptoms.

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Jay, Mike, and Bárbara Rodríguez Muñoz. This Way Madness Lies: The Asylum and Beyond. Thames & Hudson, 2016.