 Hello John here and I'm at one of the most historically significant mental health hospitals in the English speaking world with a history of over 700 years. I'm also kicking off a revival of an old plainly difficult series, Strange Places. Well it's pretty cold today so without any more delay let's go back to John in the studio. It is 1946 and a brilliantly atmospheric B movie horror is released. It will go on to lose RKO money at the box offices. The movie is called Bedlam and it is set in a fictionalised mental asylum based on one of many British society's fears that is going to Bethlehem Hospital. The hospital would become the very name to describe madness and chaos weaving itself into the fabric of popular culture with countless poems, dramas and literature works inspired by the institute. For those who entered, many never returned. The hospital represented a dumping ground for some, torture for many and a caring institute of treatment for others. The location of this hospital would change several times. With each move, the method of treatment would also develop from essentially locking up people away for good to a more human approach to mental health. This strange places history spans all the way back to the Middle Ages. Today we are going to peek into Bethlehem Hospital. Welcome to Strange Places, a revived plainly difficult series. Mental health is a story as old as time, so long as we've had brains we've been susceptible to disease and disorder. Needless to say, the way humans have dealt with mental health conditions have varied throughout the years. Often written off, mental disorders were considered the work of the devil, and as such those affected were ostracised. Throughout almost all of human history, we have had to ponder the question. What to do with those in society who have struggled with ailments of the mind? But although Bethlehem's history is intertwined with the treatment and containment of the mentally ill, the hospital's beginnings were actually very much different. Early beginnings. Our story starts in the year 1247 in the City of London, more specifically, Bishop's Gate, which is around here on an ancient map. And it's kind of near the location of modern day Liverpool Street. Gafredo di Prefeti, the Bishop-Elect of Bethlehem, was given a piece of land for the use of collecting alms, basically money and material donations for the Crusades. It was obedient to the Church of Bethlehem, and along with taking collections, who would also house the needy. In medieval parlance, the pariahy would be considered a hospital, but this is pretty different from the modern interpretation of the word. It was pretty much a charity home for the poor, ill and needy. As we know, hospitals would end up focusing more on the ill as time would go on, but this period of medieval history was just a form of religious housing. As such, because of the affiliation, all those who stayed would have to have a yellow star sewn onto their clothes to represent the star of Bethlehem. So Mary of Bethlehem, as it was known, would gradually lose its affiliation to the Bethlehem Order. And as such, the pariahy sought protection from the City of London in 1346, where the hospital became vulnerable to seizure under the reign of Edward III, where buildings owned by foreign religious organisations were ripe for the picking and reappropriation by the Crown. This was kind of linked to us English loving a fight with the French during the Hundred Years War, and as such, any form of money was always worthwhile grabbing by the King. At some point along the way, the hospital would lose its original name, being called Bethlehem, which was pretty much a bastardisation of Bethlehem, and is all too common in the English language, where words mould into something new over time. Anyways, I'll fast forward a little bit through history and to 1403, with the hospital's first officially recognised mental health patients, a charity commissioner noted on a visit of six male inmates who were mentee captee, roughly translated from Latin to English as caught in the mind. I don't know about you, but this to me sounds like someone who has become withdrawn. Obviously, this is open to interpretation, but because of the hospital's future purpose, it is possible that these six men were the first mental health patients at Bethlehem. Interestingly, some of the other items recorded at the visit, which also points to at least the hospital's need of restraint of an individual, were four pairs of manacles, chains, six locks, and two pairs of stocks. By now, the hospital's site was a single story building, covering just two acres. In the centre of the courtyard was a chapel, and the hospital had 12 cells for patients, a kitchen, staff accommodation, and an exercise yard. But sadly, there wasn't much in the form of treatment for the hospitals as they were called inmates. Due to the religious links, there was lots of Bible reading and looking for the sin that caused the condition. It was thought that corporal punishment could cure some conditions, while isolation was thought to help a person come to their senses. Okay, I'm going to fast forward a little more again here, to one of the hospital's notable keeper physicians in 1619. Because this is the first hint that the attitude was starting to form that the mentally ill needed specialist care, Helchire Crook was appointed under the encouragement of James VI and I. He was a specialist of sorts and much more qualified than his predecessors, who were largely skilled in anything but medicine, with one being a cloth maker before his 19-year tenure as the keeper of facisions. But Crook was different. He had a couple of years earlier released a hugely successful book, Microcosmografia, which looked at the human body with some rather graphic imagery. But although on the face of it, looking like a step in the right direction, much like his book, which has subsequently been thought of largely being plagiarized from other sources, quickly accusations of corruption landed at Crook's feet. And in 1632, an inquiry was held which, against others, had him investigated for failing to feed the patients. You see, a job like Crook's was largely seen as a cash cow to extort the patients and the wider public, leading to many keepers being accused of corruption. The location of the hospital was over a sewer, which led to Bethlehem being seen as a dirty place, as this sewer was regularly known for overflowing into the courtyard. The hospital became widely seen as a place of pain with contemporary descriptions of the noises that emanated from Bethlehem as crying, screeching, roaring, brawling, shaking of chains, swearing, fretting and chafing. Just two years after Crook's inquiry and the hangover that it caused, the hospital would be moved to a more modern management structure. The hospital took on a free-level medical regime, made up of a non-resident physician, a visiting surgeon and an apothecary. But although taking a more modern approach, the hospital, in its original form outside of Bishopsgate, was drawing to an end, and it would mark the first of its many changes of venue. Move one, Bishopsgate to Moorfields. At 400 years old, the original hospital was starting to show its age, being described as very old, weak and ruinous, and too small and straight for keeping the greater number of lunatics there in that present. Although having enough space for roughly 59 patients, the writing was on the wall, time to move somewhere more appropriate, and with hopefully fresher air. Construction of the new hospital at Moorfields, which is around here on the map, began in 1675 and was completed just over a year later, which was no mean feat, I mean just look at the building that resulted. Designed by Robert Hook, the hospital was a large imposing building. The grand appearance was kind of a statement to the donors who had given money for the Moorfields site, showing success. It also acted as a billboard for more charitable payments. Don't forget, this building was pre-public funding of medical institutions, and as such, income was mainly from donors, with patients' fees only covering a small amount at the cost of operation. The hospital was rather hard to ignore, with its new, bigger size, it allowed more visitors to view the building, as well as accommodate more patients. This would be the beginning of its entry into infamy. But although the building looked something like a palace from the outside, on the inside life was tough. It had been built on poor foundations, and as such, the building's grand and heavy facade pulled away from the walls, causing them to crack, allowing the elements into its long galleries and cells. It was rather like putting lipstick on a pig. Strangely, Bethlehem was best known for allowing the public and casual visitors with no connection to the inmates to come in and view the patients. Visitors were allowed to gore up and rub a neck at those who called it home. This was used in a method of raising funds. One visitor would comment, thou shalt in bedlim see one laugh at the knocking of his head against a post. This public spectacle allowed playwrights to visit who would later use their experiences and the experiences of others from the hospital in a number of plays in which actors would tread the boards of the curtain and the theatre, two of London's biggest playhouses at the time. This helped further imprint the hospital into the British psyche. As such, the name would take another bastardization from Bethlehem to Bethlehem to Bedlam, an English shorthand for mayhem and confusion. Here is an example where the Spoons was Bedlam last night when they sold out of carling. Difficult patients were called Stark Bedlam Mad. The hospital's treatment would take a dark turn in 1728 when James Monroe took over as the chief physician. He had thought treatment should involve beatings, starvation, and dunkings in ice cold water baths. This would mark the beginning of the 125-year-long Monroe family dynasty at Bethlehem, arguably one of the darkest times for the hospital. As the 18th century progressed, the straitjacket made its way onto the scene and were used to restrain the patient whilst there were force-fed laxatives in order to quite literally expel any bad thoughts from the body. Another rather popular treatment was bleeding and leaching, where incisions were made on the patient's body to allow the blood to flow out. Treatment still focused around restraint and punishment for the patient's behaviour, but the hospital yet again would be set for another move. A survey undertaken in 1791 would confirm the already apparent poor state of the building when the governors were slapped with a £8,660 bill for repair. This largely went ignored. Necessitating another report in 1799 was deemed building much like how the patients had been incurable. In 1803, the governors finally agreed on a project of rebuilding on a new site, and thus another move was required. Move 2 – St George's Fields Now, if you've done a tour of London's greatest museums, you may have actually been to Bethlehem without even knowing it. But I'll tell you why in a bit. The new hospital was yet to be built, and the Moorfield site was outright dangerous in parts. As such, patients were transferred to smaller hospitals around London, reducing the population from 266 in 1800 to 119 in 1814. Parliament agreed to provide £10,000 for the fund for a new hospital. However, this came with the caveat that the Bethlehem governors would provide accommodation for any soldiers or sailors of the Napoleonic Wars that had been deemed lunatics. A fair deal I suppose. A site was agreed upon in St George's Fields in Suffolk, South London, just a stone's throw away from the elephant and castle. The new building was in the neoclassical style, relying heavily on Hook's original plan. The new architect, James Lewis, ditched the opulent facade in favour of a far more functional and medicinal appearance. The hospital would be completed in 1815 after three years of construction, with the first 122 patients arriving in August, and over the coming years the building would get overcrowded, necessitating extra buildings to the site. Attitudes have become to move on from punishment to treatment to other asylums, such as the Quaker Run York retreat. But Bethlehem held on to the old method of restraint and religious coercion. Bethlehem operated largely without any outside inspections during the early part of the 19th century, but external oversight was eventually inevitable. This came along in 1853, when Bethlehem's exemption from outside inspection ended. The last on the Monroe dynasty, Edward Thomas Monroe, had left in 1852, heralding the era of the resident physician. With the departure of Monroe, treatment started to move towards non-restraint for the average patient. This was known as moral treatment. Outpatient treatment began as well roughly around the same time, creating the first such method of care in the UK. But be under no illusion that it was a treatment utopia. Although better than just straight up torture, treatment was still pretty harsh by today's standards. Patients were often classified as idiots still, but birds were kept in cages to allow interaction with animals, and even some found their stay at the hospital as not too unpleasant. Padded cells were still employed along with padded clothing, but were used as sparingly as possible. Sedatives such as Peralda Hyde and Hyocene were introduced in the 1880s and warm water bathing was a common treatment, with patients being required to spend up to 8 or 9 hours a day in the bath. The hospital moved towards aiming to treat inpatients for only around a year, with other arrangements being needed if longer term treatment was required. There was a small incurable wing provided, which would house some inpatients for the long haul. There was an entertainment hall which was opened in 1892, and the galleries resembled more of a holiday retreat hotel. In addition, there were outside activities such as bowls. But a story as old as Bethlehem would start to develop towards the early part of the 20th century. Yes, it was time to move again. Oh yes, I should also say that the St George's field site is actually the same building that the Imperial War Museum lives in. The third move to a sunny southern corner of London. Well, we are now back here on the boundary between Croydon and Bromley, and the hospital's current location, which is around here on a map. This would bring Bethlehem to the countryside, well at the time it was in the 1930s, and would encompass a more modern villa style building system, with multiple separate wards each having their own kitchen and other facilities. The new site would welcome a more modern approach to treatment, although the hospital would see electroconvulsive therapy and insulin shock therapy. In 1948, the hospital would be incorporated into the NHS, and would follow the more talking therapy and medicinal approach, more familiar to today's mental health treatment. The hospital has still been a bit of a source of controversy in recent years, as there have been a couple of fatalities during restraint. Now, the current hospital covers quite a bit of ground, which is good for taking long afternoon walks, and incorporates the secure wing, as well as the natural psychosis unit. Now, if you're ever in this part of the world, I highly recommend going to the Museum of the Mind, which is built inside the hospital, as it is a fascinating place to visit and learn about the history of mental health treatment in the UK. Visit the Plain Difficult Production, all videos on the channel are Creative Commons Attribution Share Like Licence. Plainly difficult videos are produced by me, John, in the currently dark and cold corner of southern London UK. Help the channel grow by liking, commenting and subscribing. Check out my Twitter for all sorts of odds and sods, as well as photographs and hints on future videos. I've got a second channel, which is made by John, which is where you'll hear this outro song in full. I've also got Instagram as well, so check me out there if you like looking at some pictures. And all that's left to say is Mr. Music Man, place our please. Identification label to the body, do not interact with outsiders. 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