Bedlam Bethlem Royal Hospital, aka Bedlam


You may have already read or heard about the novel, One Flew Over the Cuckoo's Nest, in which the workings of a mental institution in the mid-20th century are portrayed. In this novel, the patients are treated rather humanely but their lives are still under the control of staff of the institution. In contrast to this situation, the resources in this lesson will let you take a look at the bleak conditions in Bedlam, the world’s first mental health asylum, and the kind of life and treatment that mentally ill people received before the 20th century.


Visit the Museum of London: Bedlam. Explore the resources found on this site and be prepared to discuss these questions:

  • How would you describe Bedlam?
  • What story do the photographs tell you about the lives of the people kept there?
  • Given Bedlam's long history, what do you think it was like to be a patient there, say, during the 1400s? Why?
  • Compared to Bedlam, what do you think life is like for patients in mental institutions today? Why?
  • How do you think people with "acute mania" behaved?
  • Why do you think some of the Bedlam patients, like WG, were "calmed by the process of being photographed"?
  • What does the depiction of Richard Dadd tell you about people with mental illness?

Now visit Bedlam: Madness. Be prepared to discuss these questions:

  • What is "melancholia"?
  • How was "madness" portrayed in the arts in this era? What kinds of behaviors were viewed as madness by people of this time?
  • What kinds of theories or causes of madness are cited?
  • What are the "four humours"?
  • What differences are there between how Americans today view "melancholy," or "madness," and how the British viewed it at this time? 

Finally, visit The London Spy. Be prepared to discuss these questions:

  • How would you describe the attitude of the visitors to Bedlam?
  • What do you think is the reason for their critical perspectives?
  • What was the scene at Bedlam like?
  • How did you feel about the patients and what was happening?
  • Do you imagine that a scene like this could happen today? Why or why not?
  • How do you think the symptoms and behaviors of the patients would be viewed by people today?
  • How do you think the patients felt about being on display?

Knowledge Check

Read the account of Bedlam found in Henry Mackenzie, The Man of Feeling, Chapter XX. Then answer these questions, also found on the Bedlam student sheet.

  1. How does this account of a Bedlam visit differ from the visit made in “The London Spy”?
  2. Judging from the conductor, what conclusions can you make about the quality of care the residents at Bedlam receive?
  3. What is significant about the truth behind the notion that “the passions of men are temporary madhouses”?
  4. What is you impression of the story of the young lady (and her tearful connection with Harley)?
  5. To what extent do you think society is to blame for the decline of the residents and the chaos of Bedlam?
  6. What else did you find surprising, insightful, or tragic about Mackenzie’s account of Bedlam?
  7. If this was the 18th century and you had the chance to visit Bedlam, would you? Why or why not?

This esheet is a part of the Mental Health 2: Bedlam lesson.

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