Catharine Arnold has already taken us through the history of burial practices in London, in her fascinating earlier work Necropolis; here, she explores the treatment of the mad – and theories of madness – through a history of London’s Bethlehem Hospital, better known as ‘Bedlam,’ a byword for unwanted disorder and uproar. Bedlam doesn’t reach the high standard set by Necropolis; given that this work is more closely focused, the early part of the book, in which we wade through the a maze of dates and figures tracing the early history of ‘Bethlem’ from its establishment as a priory in 1247, is heavy going at times. Also, in contrast to her earlier book, histories of Bedlam, though more scholarly than this work, are already in circulation – so what we have here is an at-times frustrating mélange of the straight history of a single institution, a broader history of ‘madness’ and institutionalisation in English history, and a narrative of the evolution of concepts and treatments of ‘madness’ from roots in Greek thought and the theory of the humours,through to the bifurcation of models and of treatment into an organic-psychiatric model, as opposed to a psychoanalytic-therapeutic understanding, and the failures of so-called ‘care in the community’. Cultural history is also engaged in looking at representations of madness including Hogarth and the Victorian sensation novel. We meet a great number of significant (and often tragic) characters here, including Richard Burton, George III, Richard Dadd, Siegfried Sassoon and Wilfred Owen.
The later part of the book – that dealing with the Victorian era onwards (or is that just me?), takes off, exploring subjects such as gender, sexuality and inequality, institutionalisation by husband or family as a form of control, to the unexpected phenomenon of shellshock in the First World War and the ways in which it changed both theories and treatments of mental disturbance – for the most part, for the better. The rise of bureaucracy and institutional culture casts a constant shadow over the work, and those with an interest in other authors who’ve been concerned with these questions may find this interesting, though not necessarily new – in particular, there is an obvious resonance with the more scholarly themes of Michel Foucault, although Arnold doesn’t share his interest in the (identity of the) subject as the locus of the processes taking place here. The constant swing of the pendulum between sympathetic care (often characterised as ‘moral treatment’) and brutal violence, neglect and corrupt mismanagement is an ever-present theme. Arnold doesn’t treat some of the more interesting aspects of twentieth century mental treatment – for example, later developments in electro-shock therapy, the infamous lobotomy, or the development of Freud’s ‘talking cure’ – although these may extend beyond her (admittedly rather unclear) remit.
Although the work is endnoted, here more than Necropolis, the lack of a thorough scholarly framework for the work peeps through at times – for example, one wonders about undocumented claims such as that that the beauty marks of the seventeenth century were designed to hide syphilitic sores. More seriously, I was extremely disappointed by a coda in which Arnold trots out the damaging and hackneyed argument that antidepressants are overprescribed for the slightest lack of happiness, whereas ‘some of us’ (presumably those both wiser and more admirably fortitudinous) prefer to ‘endure melancholy in its various manifestations’ and ‘accept it as part of … identity,’ to embrace and welcome it as a teacher. Anyone who has actually experienced depression or other forms of mental illness recognizes the complete absurdity of this argument, which, though based on a soupçon of truth in its criticism of the modern self-help industry, is nothing more than a deeply self-congratulatory myth perpetuated by those fortunate enough not to have encountered serious psychic disturbance, who mistake unhappiness for mental illness, which is hence conflated with weakness, self-absorption and self-pity. One would hope that an author who had done enough research into the subject to write a book on it would have recognized this fallacy for what it is.
Despite these criticisms, however, Bedlam is an interesting work, one which I found worth persisting with, and one which, if not a thorough treatment of any one subject, is nonetheless a pleasure to dip into and an excellent collection of fascinating anecdotes and characters.