A Spy at Bedlam (Part One)

It's still the oldest psychiatric hospital in Europe.   And the most notorious.

Beginning as a priory for the New Order of St. Mary of Bethlehem  in the 13th century,  it wasn't until the dawn of the 15th century that Bethlem Royal Hospital formally became the first specialist institution for the treatment of insanity in the British Isles.   For centuries afterwards, the hospital would gain a deservedly sinister reputation for squalor, horrific treatment of mentally ill patients, and open corruption by many of the officials supposedly in charge of the asylum.  It's hardly surprising that the hospital would introduce a new word to the English language, "bedlam", and inspire countless demands for reform.  

Part of the problem was the very loose definition of insanity that prevailed well into the 19th century.  Along with patients with conditions we would identify as severe mental illness today, Bethlem Hospital was also used to warehouse people suffering from epilepsy, "moral insanity" (including homosexuality and promiscuity), as well as a dumping ground for problem patients abandoned by their families for a wide variety of reasons .  And there were more than a few career criminals there as well.   Once admitted, it was often next to impossible to be released and, if you weren't insane when you went in, chances were that insanity would soon follow given the appalling conditions found there. 220px-William_Hogarth_019[1]

Ironically some of the worst treatment patients at Bethlem received didn't come from sadistic guards or corrupt officials but rather from the well-meaning doctors and nurses.   Many of the therapies may seem appalling today though they were considered state of the art during the 17th and 18th centuries.  Along with bleeding (to remove the evil humours assumed to cause insanity), patients also had to endure frequent purging and cold bath treatments intended to shock them back to normalcy.  Needless to say it didn't work.   The worst treatment was reserved for the problem patients however, many of whom were kept chained to the walls for years. 

Not surprisingly, relegating a family member to Bethlem wasn't something done lightly.   For many families, it was considered far preferable to either confine the family member in question to a locked room in the attic or cellar or, for those families that were particularly well-off, to have their patient placed in one of the private hospitals run by physician-entrepreneurs.  The quality of care wasn't necessarily better in those hospitals, but they were legendary for being as discreet as possible.   For everyone else, there was Bedlam.   

While critical reforms slowly trickled in and Bethlem Hospital was gradually dragged into modern times, it's hard to say how many patients lived and died anonymously within the hospital's walls.  Still, over the centuries, Bethlem Royal Hospital also featured some fairly famous patients including various royal assassins (including Daniel M'Naghten), well-known artists such as Richard Dadd and Augustus Pugin, and some patients who were famous simply due to the bizarre nature of their psychosis.

Take James Tilley Matthews for example.  

Born in 1770, there is actually very little known about his early life except that he came from Welsh stock and his mother was descended from an old French Huguenot family.  Growing up to become a prosperous tea broker in London, Matthews' business interests allowed him to cross the English Channel and form important contacts in France as well.   As  it happened, relations between Great Britain and France had grown steadily worse following the outbreak of the French Revolution in 1789 and the Reign of Terror that followed.    Mathews' ties to radical intellectual David Williams and the Girondists who were part of France's ruling government made him believe that he was ideally suited to act as a peace ambassador who could prevent war from breaking out between the two countries.

Unfortunately, his ambitious plan never really panned out.  Though he tried to gain an audience with prominent British politician, including then-Prime Minister William Pitt, they all refused to have anything to do with him.  Even worse, the changing political climate in France meant that James Matthews soon lost whatever friends he once had in the French government.  The ruling Jacobins eventually concluded that he was a double agent and threw him into prison in 1793.  While this likely kept him alive considering the Reign of Terror had reached its peak at the time, the time he spent in prison, along with the constant threat of execution, likely led to the psychiatric problems that would follow him for the rest of his life..  

In 1796, after three years in prison, James Matthews was finally released after French authorities concluded that he was a "dangerous lunatic."     Returning to England, he wrote a series of letters to various prominent politicians warning them about sinister plots against the British Empire.  One politician he seemed especially obsessed with was Robert Jenkinson, the 2nd Earl of Liverpool (and a future Prime Minister).    When Lord Liverpool ignored his first letter in which he tried to arrange a meeting where he would lay out his evidence, Matthews then wrote a second letter in he stated, in part:

I pronounce your Lordship to be in every sense of the word a most diabolical Traitor. – After a long life of Political and real iniquity, during which your Lordship by flattering and deceiving, and more than anyone contributing to deceive your King, who believing your hypochictical Professions, has to the detriment of many of the Countries Friends loaded you with honours, and Emoluments, you have made yourself a principal in Schemes of Treason founded upon the most extensive Intrigue, and which have not only long since laid your Country at the feet of its most bitter Enemies, those who have assassinated France; but even comprised Projects, which after having put every Branch of the Royal Family without exception either directly or indirectly in motion to Counteract or undermine each other, have absolutely aimed at the death of your benefactor, to reap further Advantages from those who by such wickedness might in such General Assassinating scramble mount the throne.

When this letter was ignored as well (for obvious reasons),  Matthews decided on a more direct approach.  Visiting the House of Commons in person, he then proceeded to denounce the Ministry from his spot in the visitor's gallery.  As you can imagine, his public accusations of the government's "traitorous venality" didn't go over too well.  He was promptly arrested and hauled before the Privy Council which ruled that he was insane.    Despite his family's protests,  James Tilly Matthews was committed him to Bethlem on January 28, 1797 and would remain there for the rest of his life.

Once inside, he soon came under the care of the doctor who would essentially become his archenemy, John Haslam.   Though his official title was apothecary, Haslam was basically the medical officer in charge of day-to-day treatment of all the patients at Bethlem.   While technically under the supervision of head physician Thomas Munro and surgeon Bryan Crowther, neither of them were particularly involved with the hospital.  Not only was Muno rarely there (he had his own practice elsewhere), but  Crowther was an alcoholic who, as Haslam would later relate, was "so insane as to have a strait-waistcoat."

Though Haslam would, perhaps unfairly, take much of the blame for abuses at Bethlem when formal hearings were eventually held, he certainly turned a blind eye to the horrific suffering of many of the patients supposedly under his care.   Even while establishing himself as an authority on madness and authoring numerous books that became classics in their own right, it was Haslam who came under fire when James Matthews' family demanded his release.

What followed became one of the most famous legal cases in 19th century psychiatry, not to mention setting the stage for important reforms at Bethlem and elsewhere.

To be continued.




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